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.