Cranial Neurosurgery

Brain Tumour Surgery FAQs

The diagnosis of a brain tumour can be a confronting time for patients and their families. It is difficult to give general advice concerning brain tumours, since there are many different different types of tumours often requiring different treatments and having different outcomes. Please consider this advice to be of a general nature and consult your neurosurgeon for specific advice concerning your own condition.

Do all brain tumours require surgery?

No. There are many different types of brain tumours and there are specific treatment options for each type which may include surgery, stereotactic radiosurgery and even observation with serial MRI’s. In some cases surgery is clearly the best option, but not always. It depends on many factors including patient symptoms, tumour location, how certain the diagnosis is based on the scan (and whether a sample needs to be taken to get a diagnosis), and how effective the alternatives are.

How long will I be in hospital?

For uncomplicated surgeries a patient’s hospital stay may only need to be 1-2 nights. Depending on the complexity of the surgery and whether the patient has any other neurological problems or requires rehabilitation it can be significantly longer.

Can I drive after surgery?

This is individualised and depends on the type of tumour, whether the patient had a seizure and a number of other variables. Dr Jonker follows the guidelines published by the Cancer Institute of NSW.

What is intraoperative MRI (iMRI)?

Intraoperative MRI is a recent advancement in neurosurgery which allows the patient to undergo one or more MRI scans during the operation to make certain that the tumour is completely removed. It may be surprising to learn that when an intraoperative MRI is not used - even in the best of hands - studies indicate around 30% of patients will have additional tumour even when the neurosurgeon thought the resection was complete. This technology takes the guesswork out of looking for residual tumour. Please see the intraoperative MRI information section of this website for more detail.

What is awake surgery and brain mapping?

Patients with tumours that are close to the parts of their brain controlling language or movement may be recommended to undergo their surgery awake. Dr Jonker has a particular interest in this type of surgery in order to achieve maximal safe resection. The purpose of awake surgery is primarily to minimize the chance of causing a neurological complication such as paralysis or speech disturbance. It has been shown that patients with gliomas who sustain a neurological problem as a result of their surgery not only have a worse quality of life (as you might expect) but they also have a worse overall survival from their tumour(1).

Not every patient is suitable for awake surgery, and indeed it is not necessary for every patient. It is particularly useful for intrinsic brain tumours (especially low grade gliomas) located near the language areas.

What is Stereotactic Radiosurgery?

Stereotactic radiosurgery is a technique developed by neurosurgeons to treat brain tumours, spine tumours and trigeminal neuralgia using highly focused radiation delivered precisely to the tumour, contoured to the shape of the tumour, and with minimal effect on the surrounding brain or other structures. It is usually delivered as a single treatment on one day. It is non-invasive and does not require admission to hospital.

For more information see Stereotactic Radiosurgery FAQs.

References
1.McGirt MJ, Mukherjee D, Chaichana KL, Than KD, Weingart JD, Quinones-Hinojosa A. Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery. 2009 Sep 1;65(3):463–9; discussion469–70. 

Information for Patients Undergoing Brain Surgery

This information is of a general nature only. Any specific information provided by Dr Jonker should be adhered to if it differs from the information below.

PREOPERATIVE INSTRUCTIONS

Scans

Most patients undergoing brain surgery require a preoperative CT or MRI (as directed by Dr Jonker) which is registered on a computer in the operating theatre that acts like a type of ‘GPS’ for navigating accurately within the brain. Patients having surgery in the intraoperative MRI do not require this scan before surgery as it is done when they are under their anaesthetic.

Sometimes small stickers called fiducials are applied to the scalp prior to this scan being done. If you require these please leave them in place until your surgery (do not wash your hair). If they fall off leave them off and alert the team on your arrival at hospital.

It is extremely important that you bring all of your other scans (CTs/MRIs) with you for your surgery. If you believe that Dr Jonker’s office has these scans please contact the office on 1300 17 44 97 and arrange to pick them up prior to surgery so you can bring them on the day.

Medications

Blood thinning medications require special attention when undergoing neurosurgery, and usually need to be withheld for a period of time preoperatively. The following medications require attention:

  • Aspirin (including Cartia)
  • Warfarin
  • Plavix / Iscover / clopidogrel
  • NSAIDs (including voltaren, neurofen, etc)
  • Asasantin

Depending on the reason you require this medication it may simply need to be stopped, or else it may need to be replaced with blood thinner injections during the period leading up to your surgery. An exact plan should be discussed with Dr Jonker at the time of booking your surgery. Please contact the office if you believe you are on one of the above medications and are unsure what to do.

Anaesthetic Review and Fasting

Depending on which hospital you attend it may be necessary to undergo a review by the anaesthetist (Preadmission Clinic) prior to undergoing surgery. At this clinic the instructions will be given to you concerning which medications to take with a sip of water on the morning of surgery, what time to stop eating and drinking (unless otherwise stated, stop by 12 midnight on the evening prior to surgery), and what time to attend the hospital if being admitted on the day of surgery.

POSTOPERATIVE INSTRUCTIONS

Incision and Wound Care

Most cranial (head) wounds are closed with staples. An adhesive dressing called Hypafix is applied. Traditional bulky head bandages are not used by Dr Jonker.

The adhesive dressing can be removed 48 hours following surgery, and no additional head dressings need be applied from this point. The wound is left open to the air.

The wound is kept strictly dry for the first 72 hours but patients can shower if they keep their head away from the water.

After 72 hours the head wound may be wet in the shower, and the hair can be washed. Baby shampoo is recommended for the first 2 weeks postoperatively because it is mild on the wound. Care should be taken to avoid putting stress onto the wound and overly vigorous lathering should be avoided. Likewise a clean towel can be used to dry the wound but should be patted onto the scalp and not rubbed near the wound.

For the first 2 weeks the head must not be immersed in water (no swimming, or soaking the wound in a bath)

Staples are generally removed after 7-8 days (10-12 days for redo surgery). These can be removed by your local doctor (GP) using a staple remover and this is not usually painful.

Pain Relief

Patients undergoing cranial surgery usually find that the degree of postoperative pain is quite manageable, often with panadeine forte in the first few days and then panadol  or panadeine alone after this.

When taking panadeine or stronger narcotic analgesia constipation can occur so it is advisable to also take a stool softener such as Coloxyl and Senna.

Heavy analgesia is usually not required, and severe headaches should prompt further evaluation.

Physiotherapy

Patients who have a neurological deficit (things like weakness in a limb or balance problems and incoordination) will usually be referred for rehabilitation in the postoperative period.

Patients without a neurological deficit generally do not require specific physiotherapy.

Activity

After your operation strenuous exercise should be avoided for 6 weeks. Walking is good exercise and regular walking each day is recommended during the recovery period.

Sexual activity should be avoided for the first 10 days postoperatively but can be safely resumed after this.

Sleep

In general additional sleep will be required following surgery. However sleep may be interfered with by the use of dexamethasone, a medication often prescribed around the time of surgery in cases of brain tumour. We therefore try and wean you off this medication as quickly as possible.

After the first 1-2 weeks it may be best to limit daytime naps in order to try and resume a more normal sleep cycle (too much sleeping in the day can interfere with night time rest).

Driving

It is important for your safety and the safety of others that you DO NOT DRIVE until specifically cleared by Dr Jonker. When you are safe to resume driving will depend on whether you have a neurological deficit, a history of seizures, and what type of tumour you have.

Followup

The first postoperative appointment is usually at 4-6 weeks after surgery. Sometimes this appointment is held after only 1-2 weeks for the purpose of discussion of your pathology results. A CT scan or MRI will often be required, if you have not received a referral for this then please check with Dr Jonker’s secretary. Depending on your condition you may require other treatment which will be organised by Dr Jonker. In the case of malignant brain tumours common additional treatments include radiotherapy and chemotherapy.

Contact Dr Jonker if any of the following occur:

  1. Your incision becomes red, painful and swollen
  2. You have a temperature above 38.5 degrees Celsius
  3. You have severe headaches or are becoming increasingly drowsy
  4. Fluid is draining out of your wound
  5. Clear fluid is continuously dripping from your nostrils or down the back of your throat

Surgery Information