Care of Patient with Brain Tumor and Craniotomy

Major point

Brain tumor craniotomy is for reducing brain tissue compression and avoiding neurological function damage.
If the patient is taking anticoagulant medications, the surgeon should be informed prior to the surgery, and the medication will be discontinued according to the surgeon’s instructions.
After midnight of the night before surgery, please do not eat any food and drink water, wear a surgical gown, and remove underwear on the day of the surgery.
After surgery, the patient will be transferred to the intensive care unit for observation. There will be many important catheters on the body that cannot remove by yourself.

I. What is craniotomy?
Under general anesthesia, the surgeon opens the skull and removes the intracranial tumor.

II. Why is this surgery needed?

To reduce brain tissue compression
To avoid neurological function damage

III. Preoperative preparation:

Based on the location of the brain tumor, the neurosurgeon will explain the purpose and process of the surgery to you and your family members while asking you or your family members to complete the surgery consent forms, such as: restriction consent form, critical notice, and intensive care unit admission consent form, etc.
Pre-operative examinations include electrocardiograms, chest X-rays, and blood collection.
The surgeon will assess whether you need to shave some or all of your hair. Most patients do not need to shave, but rather just need to wash their hair.
The anesthesia for craniotomy is general anesthesia.
If you are taking anticoagulants (drugs that prolong blood clotting time and reduce blood clots formation), you should tell your surgeon prior to surgery and stop taking them as directed by your surgeon.
Please do not eat any food and drink water after midnight of the night before surgery.
On the day of surgery, please wear a surgical gown, take off your underwear, and remove your glasses (including contact lenses), dentures, nail polish, body accessories, and amulets.

IV. Principles of postoperative care:

After the surgery, you will be transferred to the intensive care unit for observation. If you still have an endotracheal tube and use a ventilator, then the healthcare staff will adjust it according to your consciousness and breathing conditions, and the surgeon will decide the timing for removing the endotracheal tube. You cannot speak during the endotracheal tube placement, but you can communicate with the healthcare staff with paper and pen. Never remove the endotracheal tube by yourself, as it will cause injury to your body.
In the intensive care unit, you may have a wound drainage, intracranial pressure monitoring, central venous catheter, nasogastric tube, or urinary catheter in your body due to the need for disease monitoring. When your disease condition is stable, the surgeon or nurse will help you to remove them. Never remove the tubing by yourself, as it can cause injury to your body.
A surgeon or nurse will intensely measure your state of consciousness, pupil size, pupil reflex to light, body temperature, heartbeat, breathing, blood pressure, and blood oxygen levels.
Your head wound will be covered with gauze after the surgery. Please do not scratch or pick at the wound.
With the consent of the surgeon, the nurse will assist you with progressive movements, such as raising the head of the bed and performing full-joint movements on the bed.
During the post-operational recovery period, the surgeon will refer you to the rehabilitation department and arrange related rehabilitation treatments based on your physical activities, cognition, speech, and swallowing functions. Furthermore, according to the type of tumor and the surgical resection condition, the surgeon will consult the doctor of cancer therapy for radiotherapy or chemotherapy.

References

de Almeida, C. C., Boone, M. D., Laviv, Y., Kasper, B. S., Chen, C. C., & Kasper, E. M. (2018). The utility of routine intensive care admission for patients undergoing intracranial neurosurgical procedures: a systematic review. Neurocritical Care, 28(1), 35-42. https://doi.org/10.1007/s12028-017-0433-4
Moshkovsky, F., Mercante, M., & Cipolle, M. (2018). Care of the postop craniectomy/craniotomy patient. In A. Salim, C. Brown, K. Inaba, & J. M. Martin, (Eds), Surgical Critical Care Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-71712-8_8
Stumpo, V., Staartjes, V. E., Quddusi, A., Corniola, M. V., Tessitore, E., Schröder, M. L., Anderer, E. G., Stienen, M. N., Serra, C., & Regli, L. (2021). Enhanced recovery after surgery strategies for elective craniotomy: a systematic review. Journal of Neurosurgery, 135(6), 1857-1881. https://doi.org/10.3171/2020.10.JNS203160

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