When we hear the word "brain surgery," our body goes numb, right? It immediately comes to our mind as something very serious and dangerous. It is reasonable to think so because it is actually an operation on the main center that controls our entire body. But with the advancement of medicine today, brain surgery is a much safer and more successful treatment method than before. So, to dispel the fear and doubts about this, let's talk simply about what brain surgery really is.
Simply put, what is this brain surgery?
Brain surgery is a procedure that treats an abnormal condition or problem in or around your brain. As you know, the brain is the main control center of our body. We speak, think, walk, remember, and everything else is controlled by the brain. So the main goal of this surgery is to treat a problem in the brain, without damaging the important processes mentioned above.
There are several reasons why this type of surgery may be performed. For example, it is performed to remove a brain tumor, to remove part of the brain for a condition such as epilepsy, or to reduce increased pressure inside the brain due to a blood clot or other cause. Brain surgery is also used to treat conditions such as abnormal blood vessels in the brain (aneurysms).
There are some risks associated with these surgeries, which is why you will be kept in the hospital after the surgery and the medical team will closely monitor your recovery.
Who performs these surgeries?
Brain surgery is performed by a neurosurgeon . He is assisted by a large team of specially trained doctors and nurses. An anesthesiologist is also present to administer the necessary anesthetics so that you do not feel any pain during the surgery.
What are the main types of brain surgery?
There are several types of brain surgery. Not everyone is treated the same way. Doctors will determine the most appropriate type of surgery based on your condition. Let's look at some of the most common types of surgery.
| Type of surgery | Simply put, what happens with this? |
|---|---|
| Biopsy | A very small piece of tissue or fluid sample is taken from the brain and tested. This is mainly done to determine whether a tumor in the brain is cancerous. Sometimes, this sample can be taken without opening the skull, using a small needle-like instrument. |
| Craniotomy | This is what we commonly call 'open brain surgery'. Here, the surgeon temporarily removes a small part of the skull to gain access to the brain. Then, the necessary treatment (such as removing a tumor or a blood clot) is performed and the removed piece of skull is reattached. |
| Craniectomy | This is similar to the method mentioned above. However, here the part of the skull that is removed is not immediately reattached. The reason for this is to stop the pressure from increasing due to the possibility of the brain swelling after the surgery. Later, the part of the skull is reattached in a separate surgery. |
| Deep Brain Stimulation (DBS) | A treatment for neurological conditions such as Parkinson's disease. In this, electrodes are inserted deep into the brain. A small device outside the body sends electrical signals through these electrodes to control the condition. |
| Endovascular Surgery | A modern method that does not open the skull. Here, a very small incision is made in the groin area, and a very thin tube called a catheter is inserted through it into a blood vessel. This tube is passed along the blood vessel to the brain to remove blood clots or repair blood vessels. |
| Neuroendoscopy | This is also a minimally invasive procedure. Instead of cutting the skull, a thin tube with a camera attached, called an endoscope, is passed through the nose or mouth to the brain. Surgical instruments are then passed through the tube to perform things like removing tumors. |
What types of conditions are treated with brain surgery?
There are a number of reasons why brain surgery may be recommended. Some of them include:
- Brain Tumors
- Blood Clots in the Brain
- Brain Aneurysms
- Epilepsy
- Traumatic Brain Injuries and Skull Fractures
- Bleeding into the brain (Hemorrhages)
- Accumulation of fluid in the brain (Hydrocephalus)
- Stroke
- Parkinson's Disease
How do you prepare for surgery?
Brain surgery is a very planned procedure, and your medical team will prepare you well for it.
Preoperative tests
Before surgery, your doctor will perform a physical exam and perform several blood tests to make sure you are in good health. In addition, they will perform tests such as the following to get a very clear, detailed picture of your brain:
- MRI (Magnetic Resonance Imaging) scan
- CT (Computed Tomography) Scan
- PET (Positron Emission Tomography) scan
- Angiography - to examine blood vessels
The images from these scans help the surgeon accurately identify the exact area that needs to be treated.
Preparations need to be made on your part.
Your surgeon will inform you about the following before the surgery:
- Changing your health habits: If you are a smoker, you should stop smoking completely at least a few weeks before your surgery . Smoking increases the risk of complications during surgery and delays wound healing.
- Medication management: You may need to stop taking some medications (especially blood thinners ) a few days before surgery. Your doctor may also recommend starting new medications to prevent brain swelling, infections, or seizures.
- Understanding the Surgery: Your surgeon will explain the procedure, possible side effects, and what to expect after surgery. Ask any questions or concerns you may have at that time.
What happens during the surgery?
This will vary depending on the type of surgery you are having. For example, let's take a step-by-step look at how to perform an 'open brain surgery' (`Craniotomy`).
1. First, the anesthesiologist will put you under general anesthesia. This means you won't feel anything, you'll be asleep.
2. The hair around the surgical site is removed and the area is thoroughly cleaned.
3. The surgeon makes an incision in the skin of the scalp.
4. Then, a small section of the scalp is carefully removed using a special surgical instrument (`surgical drill`).
5. Now that the brain is accessed, the necessary treatment (e.g., removing a tumor, removing a blood clot) is performed.
6. After the treatment is complete, the removed part of the skull is reattached to its original position, using special small plates and screws.
7. Finally, the incision made in the skin is closed with stitches.
Important: Not all surgeries involve opening the skull. In procedures like `Neuroendoscopy`, instruments are passed through the nose or through the groin along the blood vessels in `Endovascular` surgeries, allowing treatment of the brain without making any major incisions.
Will I be awake during the surgery?
This is a problem that many people have. In some cases, yes, you can be kept awake during surgery.
Most surgeries are usually performed while you are fully anesthetized. However, some types of brain tumors and surgeries for epilepsy require you to be awake. Don't worry, your head will be numbed with anesthetic, so you won't feel any pain.
The surgeon does this to make 100% sure that important brain functions (such as speaking and movement) are not damaged. During the surgery, doctors will ask you to talk, identify a picture, or move an arm or leg. When you do these things, the surgeon can perform the surgery without damaging the parts of the brain involved in those processes.
What happens after the surgery? What are the risks?
After surgery, you will be kept in the hospital for observation for a few days. After open surgery, you may stay for about 10 days. You may also be kept in the intensive care unit (ICU) for the first day or two.
It is normal to feel tired, sore, and have headaches after surgery. The medical team will give you painkillers to help with this. You will also be prescribed medication for a period of time after surgery.
Possible complications and side effects
Like any surgery, brain surgery has some risks.
| Risk type | What is included? |
|---|---|
| Common risks associated with surgery | Bleeding, infection, adverse reactions to anesthesia, headache. |
| Temporary side effects that may occur after surgery | Difficulty speaking, brain swelling, confusion, dizziness, problems with walking or balance. |
| Long-term risks | Behavioral changes, memory loss, speech problems, limb weakness, and some brain damage. |
Importantly, these risks have been greatly reduced with modern, minimally invasive surgical techniques. Your doctor will clearly discuss the risks specific to your situation.
How long does it take to heal?
This also varies depending on the type of surgery. With minimally invasive surgery, you can recover in a few weeks. With open surgery, it can take anywhere from 6 weeks to several months to fully recover.
Some people need rehabilitation after surgery, which means helping to restore normal body function through things like speech therapy and physiotherapy.
When to see a doctor
It is normal to experience some discomfort after surgery. However, there are some symptoms that you should be aware of. If you have any of these symptoms, tell your doctor immediately:
- Difficulty or inability to control urination.
- Unusually falling asleep or being difficult to wake up.
- Fever, vomiting, or nausea.
- Severe headache or neck stiffness.
- Severe mental confusion, major change in behavior.
- Difficulty seeing, hearing, or speaking.
- Numbness or loss of feeling in the hands, feet, or face.
- Loss of consciousness.
These are emergencies! Go to the hospital's Emergency Department (ETU) immediately!
- Difficulty breathing
- Having a seizure (convulsion)
- Symptoms of a stroke (drooping on one side of the face, numbness in an arm, difficulty speaking)
Take-Home Message
- Brain surgery is a very advanced and safe treatment today, so don't be unnecessarily afraid of it.
- There are many types of surgery. Not all surgeries involve opening the skull. Doctors will choose the safest and most appropriate method for your condition.
- It is very important to follow your doctor's instructions carefully before and after surgery. Be open with your doctor about any concerns or fears you may have.
- Brain surgery is performed to save lives and improve the quality of life. Therefore, it is a very important treatment for serious conditions.
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