Thursday, November 20, 2008

What to Expect When You're Expecting A Craniotomy!

Here beginneth, by the way, a series on what patients can expect from various fun procedures that are common at Sunnydale General.

So you're having a craniotomy. Let's gloss over, for the moment, whether it's for a tumor or an aneurysm clipping or an external-to-internal carotid bypass, shall we? Most craniotomies have the same side effects and recovery time, so we'll ignore the whole range of reasons for them and focus on the important thing: Somebody way smarter than you will have his (or her) fingers in your skull.

Actually, that's not quite accurate. Somebody way smarter than you will have a series of microscopic instruments inside your skull. The point is, though, that your skull will be opened up (a thing that's never meant to happen) and closed again. Great. What can you expect from the process? Read on:

Prior to Surgery

The day of surgery, you'll be expected to show up at the hospital early in the morning, probably with freshly-shampooed hair. You'll be hungry and thirsty, having not had anything to drink or eat that morning. Somebody will start an IV line on you and fluids, which will help with the thirst part, and give you a dose of something to make you happy. Then you'll be wheeled into the operating room.

Surgery Itself

At this point, one of two things will happen: you'll either be put out completely by the friendly anesthesiologist, or you'll be moved to the operating table, *then* be put out by the F.A. Your head will be positioned in a head-holder (tough medical terms, I know!) and anything from a small strip of hair to half your head will be shaved, depending on the surgeon.

Note: Most docs now shave only what they have to, so don't think you'll lose all your hair.

While you snooze, your head will be scrubbed with a sterilizing soap and draped with sterile drapes. Somebody else will be working on your other end, putting in a urinary catheter.

Once everything is ready, you'll have surgery. Since I have no clue what actually goes on inside the brain during surgery, and you'll be asleep for it, let's move on to the post-surgery period.

After Surgery

You'll wake up, more or less, in the ICU. You'll have wires on your chest, IV and intra-arterial lines in your arms and possibly feet, and you'll feel like hell. Your throat will be sore from the breathing tube they put down you to keep you breathing, and you'll still have that damned catheter in. You'll also probably have a doozy of a headache. This will all cease to matter as the fact that you're in the ICU dawns on you, and you have to cope with bright lights, beeping machines, and nurses coming in every few minutes to make sure your neurological exam hasn't changed. Expect them to ask you silly questions like "What day is it?" and shine bright lights into your eyes over and over. 

After a night or two in the ICU, you'll be moved to a neurosurgical acute care unit. All but one or two IVs will come out, along with the line in your wrist that monitored your arterial pressure. Expect some major bruising there, by the way.

After I introduce myself, I'll take out your catheter. You have eight hours to pee, which shouldn't be a problem. The catheter removal doesn't hurt (at least the way I do it) and you'll feel a lot better after it's gone.

You'll be able to eat regular food if you can, and I'll manage your nausea if you're feeling queasy. Don't ask for Phenergan, by the way, since you won't get it. It makes you too sleepy.

I'll be checking your neuro status every four hours, or more often if I'm a tad worried about you.

The first afternoon out of ICU, you'll probably sleep. This is normal. You might feel *great*, what with all the anesthesia still in your system, but you'll be sleepy the next day for sure. Either way, sleepy or not, you're getting up into a chair and walking a little bit, just so I can be sure everything got put back into the right place.

Okay, So Now What?

Let's take a look in the mirror, shall we?

You'll notice that, if your incision is along the front or side of your head, you have a whopping black eye and a whole lot of swelling on your face. This is totally normal and will go away completely within about ten days. You'll also see a shaved strip or patch of hair with either staples or sutures in it. That's where they went in, and those staples/sutures will come out in about ten days, just as you're looking less like you've been hit by a truck.

You might have punctures in your forehead from that head-holding widget I mentioned earlier. Those will heal and leave very small scars if there are any scars at all.

There are probably bruises on your arms from the IV and a huge bruised area on your right wrist from the intra-arterial line. Your jaw (if your incision is in the front or side) is sore, or your neck (if it's in the back) feels like you have one hell of a crick in it. We can take care of that; just ask for pain meds.

You will probably hear ticking, dripping, thunking, swishing, or popping noises inside your skull, especially if the incision is on the front or side, or around your ear. That is Totally Normal, and is a result of air in your head moving around. You are not insane. The surgeons *always* forget to mention that, and it makes people worry.

You will get very tired very easily. Keep this in mind. You'll find that mental things, like crosswords or reading, tire you faster than physical things. This is because you're basically trying to walk on a sprained ankle--in other words, you have to keep using the part of your body that's been injured or insulted, even as it heals.

Even with the tiredness, you may have trouble sleeping. This is due entirely to the fact that you're getting Decadron, a steroid, to reduce swelling inside your brain. That side effect will go away as soon as we start tapering (lowering the dose) of Decadron, so don't fret. In the meantime, ask for a sleeping pill.

You'll notice that I'm loading you up with laxatives and stool softeners. This is a major deal, since constipation goes hand-in-hand with pain medicine, and I don't want you straining. If you go more than two days without pooping, I will take Drastic Measures. 

Speaking of pooping and peeing, I'll take great interest in how much you drink and how much you pee. This is because opening the brain or spine can lead to various problems with how your body handles fluids, and I want to make sure that's not happening with you. 

After Discharge

When you go home, you'll want to take it easy for two to six weeks. Walk, eat, sleep, sit up in a chair, be calm. You'll have a followup appointment in about two weeks with your surgeon, at which time you'll chat about the surgery and he'll make sure he didn't leave any bits out. 

Make sure your diet is good. Your appetite will probably suck, so eat good food when you get hungry. Include protein and some fat. Avoid junk. Drink plenty of water.

Nap occasionally. Let your body tell you what it wants to do.

And don't worry about screwing something up. Depending on your doctor's orders, you may or may not put antibiotic ointment on your incision or take oral antibiotics. As long as you don't scrub the incision line with a toothbrush (and yes, I have had people do that), it won't get infected.

Don't perm or dye or relax your hair for about six weeks after the staples or sutures come out, though, 'cause that scar is still delicate. And don't use a hairdryer: it'll cause staples to become uncomfortably hot.

Finally, remember that you have had brain surgery. It might be six months before you get your stamina back, okay? Take it easy. In a year, this'll all be a bad memory.

Here endeth the first lesson.

40 comments:

Penny said...

"...at which time you'll chat about the surgery and he'll make sure he didn't leave any bits out."

Oh, I hope not. What if it's the bit that tells me how to blow my nose? I hope all those bits get put back in. The bit that houses the memory of Randy Barrett from college can go. Like, down the toilet, please.

geena said...

"As long as you don't scrub the incision line with a toothbrush (and yes, I have had people do that)"

Oh, GOD!!! That isn't right.

I didn't know about the popping and such from air in the head.... I thought air in the head was Bad. I guess it's caused by ... I dunno... microair?

rosebuttons said...

Thanks for writing this, it's awesome! I work in a hem/onc BMT ICU, but once in while we get the crani overflow from the other ICUs. They always freak us out a bit since we see neuro pts so rarely, but this gives a great perspective when thinking of how to educate our pts and be more comfortable with their procedures. Maybe I'll get around to writing "What to expect when you're expecting a stem cell or bone marrow transplant" some day...

Strong One said...

"Speaking of pooping and peeing, I'll take great interest in how much you drink and how much you pee" ~
I love it!
Great commentary from the 1st through the 3rd person point of view.
Maybe we should replace patient information hand-outs with your narratives?
:)

Anonymous said...

Our friend Catherine and I agree, the sendup of a relentlessly cheery patient information brochure is dead on, but, as she said, 'I wish I'd had that much information before I went in.' [NOT a craniotomy]

Priceless.
Mom

shrimplate said...

All that craniotomy stuff sounds great. When can I get one?

Chimera said...

I'm not medically inclined, just a psych social worker, nor have I or anyone I know had a cranial procedure but I found this fascinating. I'd love to see more.

Meags said...

Loved it.....having my crainy next tues. 9/12/08. Being a orthopeadic nurse a little knowledge can really put the bloody wind up you..humour softens everything..........thanks for making me laugh will try and remember this next week....between me sleeping in the chair and drinking heaps to prevent another IDC and enjoying the multicolours around my right eye.

Sebrena said...

Awesome nice to know what happens before and after we do what we do-BTW putting the holders (skull pins)in makes me want to wet my pants when I see it so I don't look!
OR RN

Anonymous said...

OK, I am looking at having my little skull cracked open and I am terrified. My doc is Dan Barrow @ Emmory. How much more can you tell me? I have a Cavernous Malformation in Right frontal lobe that hemmoraged 5 years ago. now have partial seizures. Am being recommened for surgery to avoid another bleed in another pregnancy. (my last bleed was during prenancy @ 4.3 cm).
HELP...mama wants to keep her head sealed up...but she also wants another baby and not more bleeds. I am trying to get in better shape to better recoup...any advice, more pearls of wisdom...love this blog AWESOME. so funny and informative!

Tanya said...

I work at a neurosurgery practice. I think it's hilarious and fabulous that when I entered "craniotomy patient information brochures" into Google your blog was the first thing that came up. Really enjoyed reading it. Most of us in the office never go to the hospital and have no first-hand experience with what our doctors actually do or how our patients are affected. This really gave me some perspective on what our patients go through. I forwarded it to our surgery schedulers and mid-levels... :) Thanks!

Anonymous said...

I am 11 days post crainiotomy to remove a benign meningioma (tumor slowly growing from the covering of my brain). It was small (less than 2 cm), and approximately under my hairline at my left forehead. My staples come out in 3 more days. I have been sleeping in my recliner, more or less sitting up,and I have had no bruising of my eye or face. I haven't felt badly at all, even immediately post surgery. I only used pain pills at night the first night, and during the day three days, two days on tylenol, then nothing. I credit my easy time to a brilliant neurosurgeon and a briliant anesthesiologist. But I also credit Bellaruth Naprastek, whose CD titled "Successful Surgery" I listened to repeatedly the week before the surgery. It includes a guided imagery exercise and affirmations. I highly recommend this to anyone approaching surgery. Having a positive attitude is particularly important in recovery from brain surgery, and I think this product has helped me enormously. Bless all of you who assist in these surgeries and bless all you who are pre or post craniotomy. Mary

Jared said...

Found your blog the night before my wife's craniotomy. It was quite helpful and funny as well. She's now day +1 post-op and doing well. Your descriptions were spot-on.

Margie Bargie said...

Had my surgery the week before last and like your blog I have been using humour to explain a lot of these things to my friends and family and I found as a consequence that it has made the whole process much less scary for them and for me. I laughed at the part about the hair drying - I am from Montreal (a city of women who like to look after themselves - grooming is very important to us) and learned my lesson as far as which direction to point the nozzle of the dryer (ouch). I have had my staples out yesterday (had to go twice because the original doctor forgot one in there - thank goodness my husband was curious enough to want to see what it looked like sans metal) and am still amazed that in week two I am doing so well.
Good luck to all of you who are reading this before surgery - do not be frightened as this surgery is pretty common from what I can tell - and while it is a bit overwhelming you will be so glad when it is done and it is likely to afford you a new lease on life and a pretty amazing degree of gratitude for what you have!

Anonymous said...

Thank you for writing this. My one year old son goes in for a craniotomy next week, and I am terrified. I don't know how to help him and I'm scared. Your info helped, and your writing style makes it less scary.

Anonymous said...

Im four weeks post surgery, and yes, this blog is spot on! It is a little scary the surgery, but I am recovery very well. The only issue that I have is the tiredness and a bit of spinal and neck pain. I look forward to the six week turning point post surgery!

suzstow said...

this is the best feedback I have found had surgery 5 weeks ago, wish I'd found this before

Anonymous said...

Do any of these things get left off if you are just having a craniectomy to remove a calvarial hemangioma, not brain surgery?

Hilpod said...

I just had my craniotomy for removal of a cavernous malformation in my right parietal lobe. It sucked, but quickly got better. I left the hospital after two days and have been home for one day - besides a little freak out after an intense pooping session, I have been great and already feel the effects of having that little bugger taken out.

Megan said...

I love this! I am having a craniotomoy in 4 days and this actually helped ease some fears. :)

http://megsholeinherhead.blogspot.com

Anonymous said...

My daughter in law is having a craniotomy to remove a meningioma from a vein at the base of her brain on November 6th. She will be 35 years old tomorrow is the mother of 3 little boys ages 5, 3, and 1. She is surrounded by friends and family and has so many prayers going to heaven for her. This post was so informative and helpful. It is easier to deal with it just knowing what is going to happen. Thank you for this. It means a lot.

Anonymous said...

Penny. What's with the symbol you use as your thumbnail? Where's it from?

Anonymous said...

I had a craniototamy three weeks for a LARGE meningioma. Three months of headaches significant memory loss toward the end led to an ER visit CT scan and diagnosis. This write up is exactly what I have experienced.

Three weeks later I feel much better, I am off most of the medications (Decadron), but I still have trouble sleeping. I never in my life had a hard time falling asleep but now even when I am exhausted I will lie there awake. The Doc told to take Benadryl which helps some. I seem to stay in a dream state and I wake up from these stressful dreams. I never used to remember my dreams before. Anyway, I like your article it is very informative for patients.

kbella21 said...

This is a very Good reference. i had my surgery on the 18th of last month and everything here is exact.

good luck said...

thank god for smart nero surgeons and smart sweet nurses, i have hadlaser and cranitomy :) i was on a walker a few days, but my tg pain subsided, and i no longer wanted a bullet to relive the pain.that fifth cranial nerve is a mf :) anyhow i have ms so trust me it was all well worth a few weeks of pain, after surgury if the meds they use to knock you out upsets your stomach and makes you throw up ask for some dramamine, dam that did the trick for me, my son just happen to be in the icu when i was sick ocming outta surgury he said get her some dramamine, thank god for smart kids also, army recruter iraq war dont forget a lil prayer for the drs and nurses and of course for you

Anonymous said...

Hi I had a Craniatomy 2 weeks back. Great article, very accurate! I had aching but and lower back nerve aches for 4 days after surgery. Did some nerve stretches eventually and pain subsided. Eyes feel dry and get tired quickly. Looking forward to 6 week mark. Don't fear pain of a Craniatomy..you don't feel anything and God helps mental fear.

Anonymous said...

Your view is delightful, however this is not my story.:-) Feb 26,angiogram felt as if someone poured kerosene on either side of my bottom jaw and lit a match. Dr.shoved the canula on my right groin vein, like a rotor rooter, it hurt. They were playing "we will rock you" by Queen, no thanks. 28 of Feb actual surgery. Lovely they all said I had beautiful hair. I just smiled, I mean what intelligent person cares about their hair when their brain is about to be manipulated? In ICU crescent shaped sutures from ear to ear. They left almost all my hair? interesting I thought. Pain in sutures, blood every single day in mucosa of the nose, no sleep, Decadron made my legs weak, I had taken my laptop, and my books, got to read only one. Too tired. My vision is worse than when I went in, only had left eye visual cut, now it's across both eyes and no deep breathing makes it go away like prior.

Then came the Heparin, seems I had to blood clots in the lungs. It was difficult to get my INR level to 2.

Then I began to research. Coumadin? rat poison? not me buddy. They sent in a psychiatrist to determine if I had the "capacity" to refuse it. I did. She was adorable and smart and reminded me of Dr.Joyce Brothers crossed with Dr. Jill Biden. The neurology team was up in arms. LOL.

Coumadin does not dissolve clots, they are absorbed by the body but can prevent new ones for forming. I still said no thank you. They took me off the Decadron, fluid remaind under the sutures, they misrepresented sutures vs. staples and oh by the way the titanium plate.

Today is 4/1 wish I could say April fool,but it's not a joke. I came home yesterday. That's 30 days, went to rehab which was intersting, cooked a meal, and other light stuff for 5 days.

Meanwhile I put myself on Occuvite, they said ok, Cod Liver Oil, ok, I asked for a multi-vitamin, B-12 -and ate very well, not to my liking but very healthy.

Today my first day home, I will put cold ice and salt on my head to bring down the swelling which went up from 0.8 cm on March 8 to 1.6 on March 31 which I demanded that they take a ct scan to prove that there was increasing pressure.

I walk wobbly, though I know I will improve because ONE day I was my normal fast paced self but I relapsed. I also woke up very happy ONE day, which matched how I used to wake up everyday of my life. I am 64. Bad part is I look very young and I am an anthropologist with 40 years of knowledge and research and they said I was doing fabulous. ah...no I am not.

I am glad you chose to highlight all of the comments that were very positive but life is not like that.

After surgery I read about the operation, would I still have it? no. It shortens your life span, where as having the meningioma inconveninces one, but I had no headaches just the visual disturbances that I could control with breathing and not keppra. Oh am off of that also. That's what researching does, give you options.

I also have nerve or tendon injury from a phlebotomist who had no business going into any of the 3 veins in my inner wrist. But I think it will heal in about 6 months.

I am sure I will be fine in six months, will re-enroll in law school, and enjoy life. But this was a fun reading!! Thank you.

Yes am real and on Twitter and I made comments there.

Anonymous said...

Read this to my family as my mom was in surgery. I can't tell you how well-written and informative this was. We all felt so much more knowledgeable conversing with her nurse after. Thanks a million.

Catherine said...

Oh, thank you head nurse! Humor has assuaged the savage beast, Fear. I will sleep better in the nights ahead. Craniotomy set for week and a half from now. So scared. Love the phenergan reference. I am a nurse...pts ask for phenergan instead of odans etron all the time. I get it! They want it with the benadryl and dilaudid all together. I love the title, "head nurse." I'm trying to choose an analogous name for myself. Kidney, pancrease, immune system, withdrawal nurse...doesn't have same je ne sais quois. I have been the charge nurse on occassion...an event that brings jeers from oncoming shift and always results in mutiny on the bounty, especially with regard to the assignment. I throw up my hands. I will approach this craniotomy, with it's vast unknown entities, with aplomb rather than timid defeatism, thanks to your thoughtful words. I thank you again and will make every effort to poop and pee accordingly and not to complain about being OOB to chair. Wonderful.

Mandy McCracken said...

This is 100% accurate. I had my third craniotomy in January '13 to remove another meningioma (darn things keep coming back). I wish I had read this before my first surgery in 2007. The one thing different with my first surgery is that I had a seizure before. I was on a crapload of steroids and had every side effect imaginable. It took six months for the steroid acne and moon face to totally go away. I'm a skinny minny, so it was obvious just by looking at my face that something was not ok with me. To say the least, this last surgery was a piece of cake compared to the first. Steroids suck!
Thanks for this article!

Toy Howard said...

When can I cut my hair after the surgery

Paul Addison said...

My sincere thanks for this article. I am trying to stay as stress free as possible prior to the Op and avoiding some of the more lurid US sites. The detail here is just whay I needed and I am very grateful.

Anonymous said...

Kate: hi, just wanted to say a Huge thank youa to all the feedback of all you experiences. I am due to go in on the 14th jan for a craniotomy to remove a meninginoma and A nerve wreck to say the least!! I am interested to hear if anyone has experienced any tinnitus both before or after? I'm 36 mother of two beautiful young children and this all began wit have series of 'ear infections' which eventually led me to the ent and an MRI. The tinnitus started so suddenly at the same time and they seem to think its unrelated but I'm convinced otherwise....really hope it goes away post op!!

Kayden Van Horn said...

I really wish I had read this before my crainiotomy, but you know we never do research until after because we are still thinking, well I am still thinking I am insane two weeks later for hearing dripping and swishing in my ear and having a lot of preasure. So naturally, I Google it. Thank you for writing this. They should give this out with the pre op checklist! :)

Anonymous said...

I had a craniotomy 3 1/2 months ago and it was preceded by waking up one morning with severe noise sensitivity in one ear as well as distortion of sound in that ear. The MRI to diagnose my ear problem didn't find anything except a huge meningioma on that side of my head. The noise sensitivity resulted in huge tinnitus and like the writer just above this, I was told it was not related to my tumour but like her, I'm hoping it is. Now three months out, I still have loud tinnitus in that ear but the noise sensitivity has decreased significantly. I'm hoping the improvement is my brain working to fix this and am hopeful in another three months my hearing will improve too. I'm getting better every day but still have a lot of fatigue so am living quite a quiet life for now.
Thanks for this great blog - I wish I had read it before my surgery because it is really a realistic depiction of post surgery.

afad real love said...

can somebody tell me side effects of craniotomy ? and if we operate it will it disappear forever or is there any chances that it will come back ? thank you

Karen kaapuiki said...

What a great way to truly understand what I am going to be put through w/in a week or so...I am a nurse working w/ 'Special needs' kids in -home care. Not only does this informative article give me more of an understanding, yet will also be very helpful for further cases, as I will be able to help theses wonderful pts.'s parents be more aware pre/post- op. Thank you so very much for taking the time and caring about people like myself. God bless you. 4/29 is approaching quickly, as I was dx w/ a brain aneursym Nov. 1st 2013. Going to print out and pass to my family / and friends Khat are feraking out FOR me. karen M. Akana-kaapuiki

nancy said...

I had a craniotomy 10 months ago after having an aneurysm rupture. now my temple area by where the craniotomy was is "sunk" in.. I feel pressure in my eye on that side... Is this normal?

justanordinaryperson said...

I'm having surgery for a meningioma soon. Thanks for sharing your experience!

Cassandra Allred said...

Terrific, honest, funny love this. So true! The crackling and clicking I thought my head was coming open again. Scary.