martes, 11 de junio de 2019

Preparing for Brain Surgery

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By Tim Boughton, M.Sc.Reviewed by Dr. Jennifer Logan, MD, MPH

The lead up to brain surgery can be a stressful time. It is recommended that you ask your neurosurgeon any questions you have, no matter how trivial you think they are. The greater your knowledge of the procedure, the less frightening it will seem.

Surgeon carrying out brain surgery - By Gorodenkoff

Gorodenkoff | Shutterstock

Having a better understanding will also reduce any fears of the unknown and help you to feel more in control of the situation. Write your questions down before any appointments with the consultant, and take a family member or friend with you for support. Making nice plans with friends and family throughout the weeks leading up to surgery may help to relieve the anxiety which you may be experiencing.

Advance directives and living wills

While the chances of serious complications are low for most neurosurgeries, all surgeries carry some risk. Make sure to have discussions with your family members about your wishes in the event of something unexpected happening, or if you are unable to make decisions for yourself.

Patients undergoing any type of surgery should consider completing a Living Will and nominating a power of attorney before surgery.

Preparing for post-surgery

In the weeks leading up to surgery, you should consider putting in place practical coping strategies to help aid your recovery post-operation, such as:

Prepare and freezing nutritious meals
Make necessary adjustments to your bedroom and bathroom
Get ahead on household chores
Collect any books, magazines, and movies you may want to read or watch post-surgery
Arrange any cover you need at work and create a return to work plan with your management
Plan for any childcare needed
Arrange travel to and from surgery

Pre-operative medical checks and appointments

In the week before surgery, you will meet with your treatment team. Here you will be briefed on the operative procedure, the benefits, and risks of surgery, and what to expect post surgery.

You may be required to undergo health tests and checks to make sure you are ‘medically fit’ for surgery. It is important to make sure your physician is fully informed of your medical history and knows of any medications you may be taking. The tests carried out vary considerably depending on your medical history, but may include:

Blood pressure tests, pulse, and temperature
Blood tests to check for hormone levels and chemical markers
An angiogram of your blood vessels and blood flow
An Electrocardiogram (ECG) & echocardiogram to ensure your heart is healthy
Lung function tests & chest x-ray
Neuropsychologic examinations if your condition is affecting your cognition

These checks help to identify and optimally treat any underlying medical conditions which could cause further risk from surgery.

You may be asked to stop taking certain medication a week or more prior to surgery (such as anticoagulants like warfarin, or antiplatelet drugs like aspirin). You may also be asked to take certain medications in the week before your surgery (such as steroid agents which reduce swelling in the brain, or anti-seizure medication).

Preoperative imaging tests

Several imaging tests may be conducted leading up to your surgery. These include:

CT scans
Magnetic resonance Imaging (MRI)
Diffusion Tensor Imaging (DIT)

These images provide a 3-dimensional map of your brain structure and function. This helps guide the neurosurgeon to plan the procedure and avoid any areas of the brain associated with important functions.

Fiducials

Your neurosurgeon may place fiducial markers to pinpoint certain areas of your scalp for surgical incision. The fiducials are small stickers which are painlessly placed on your scalp pre-surgery. It is important not to move the fiducials once they are placed.

Packing a bag

You may wish to pack the following items to improve the comfort of your stay in hospital:

Any insurance documentation
Pajamas
Day clothes
Clean underwear
Dressing gown and slippers
A small towel
Toiletries
Reading material
Some loose change
Any medication you need
Glasses or contact lenses
A notebook and pen
An address book with any important phone numbers
Phones, tablets, laptops and MP3 players if permitted

Hygiene

It is important to remove any body piercings before your operation. This helps to minimize the spread of harmful bacteria throughout the hospital. You must also remove all makeup and nail polish so that the surgical team can see your skin and nails to monitor your circulation. Many hospitals also require you to shower or bathe before surgery.

Fasting

Your doctor may ask you to not eat or drink anything for a period of time before the operation. This is crucial as you need an empty stomach during surgery, to ensure that you do not vomit while under anesthetic.