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Brain surgery: when is it necessary and what are the risks?

Whether brain tumors, Parkinson's implantation, relief surgery or epilepsy surgery - brain surgery is one of the major challenges in everyday surgical practice. No organ has been so little researched and no operation requires such precise preparation as the intervention on the brain.

There are various clinics that specialize in neurosurgery and also offer special forms such as surgery with awake phases. There are also certified rehabilitation centers for people after brain surgery, which are specially geared towards the needs of neurological or neuro-oncological patients.

In this article you will find out everything you need to know about brain operations, the indications, the process, the risks and the prognoses.

Operate on a brain tumor

In most cases, brain surgery is performed as part of an oncological disease. Whether brain metastases, brain tumors or meningiomas - brain surgery is the most important pillar in the treatment of neuro-oncological patients. In addition, operations on the brain due to cancer are the most common indication in neurosurgery.

The most important criteriawhen brain surgery can take place because of a brain tumor

  • good accessibility for the surgeon
  • rapid tumor growth and aggressive infiltration or displacement of other structures
  • a good general condition of the patient

 

Every malignant brain tumor is usually operated on with the aim of striving to partially or completely remove the tumor, to remove an obstruction to the flow of liquor caused by the tumor or to create an improved starting position for subsequent therapies.

But also benign, i.e. benign, tumors can have severe deficits in the areas of motor skills, language, vision, coordination, balance or memory and are also operated on if the situation is good. Through an OP, a benign tumor often completely removed. But even in the case of a subtotal resection, the quality of life of those affected improves considerably in most cases.

 

Operation brain - other clinical pictures

Various diseases can also make therapeutic brain surgery necessary. However, these are still exceptions and account for around 15% of neurosurgical operations.

This includes, for example Relief in the event of a traumatic brain injury or after a cerebral hemorrhage, to protect the brain from damage from the increased pressure. Removing part of the skull bone can have a positive effect on recovery by protecting nerve cells from pressure damage.

Also one Shunt placement in case of disturbed liquor outflow prevents deficits caused by pressure-related cell damage in the brain. Because of malformations, the permanently newly formed cerebrospinal fluid (liquor) cannot drain away and then has to be conducted from the brain into the abdomen using a small tube. There the liquor is broken down and the brain is relieved.

Likewise be Brain aneurysms supplied as part of a brain operation. The repair of the bulging vessel walls takes place with cooling of the brain and with connection to a heart-lung machine and can only be done in selected centers.

As part of the Epilepsy treatment As in Parkinson's therapy, doctors rely on neurosurgical interventions. The implantation of a neurostimulator, if diagnosed early, can alleviate the extent of the disease in question.

 

The brain surgery procedure - how is a brain tumor removed?

Depending on how fast the tumor grows and which area is affected, the preparation can take several weeks.

 

Stereotaxic and neuro-navigation before surgery

If the tumor grows in a very unfavorable location, is very large and is removed in several sessions, or if the patient is in a poor general condition, the surgeon will remove part of the tumor with the help of stereotaxic or neuronavigation. In the context of stereotaxy, the tumor is calculated and targeted using mathematical calculations. Neuronavigation calculates the position of the tumor using magnetic fields and ultrasonic pulses. A computer stores the data and creates a three-dimensional image. During the operation, the surgeon uses this image as a guide and guides the instruments through real-time CT and MRI images. This makes it possible, on the one hand, to use the computer to make various brain structures visible and to protect them.

On the other hand, the surgical instruments and the position of the tumor can be displayed on a screen at the same time, so that the surgeon can take a sample or remove part of the tumor.

 

Neuromapping on the conscious mind before surgery

The operation, known in technical jargon as awake cranotomy, is carried out in particular on people whose tumor is in the area of ​​motor or linguistic areas. Also within the Epilepsy and Parkinson's Therapy a waking operation is performed. This requires a so-called neuromapping beforehand. A map of the brain is created in a magnetic resonance tomograph. During these recordings, the patients have to perform various tests, for example counting, arithmetic, reading, reciting days of the week, solving memory tasks, etc.

The magnetic resonance tomograph shows which areas in the brain are activated. This enables the surgeon to better delimit the healthy areas from the tumor in a later operation.

 

The ultimate course of brain surgery

The open operation aims to completely or almost completely remove the tumor. The focus is on maintaining all neurological functions. In order to achieve this goal, the surgeons use all techniques during the operation to visualize healthy areas of the brain. These include, for example, CT and MRT imaging, fluorescence-assisted resection, ultrasound and neurophysiological tests in the wake phase.

The process of brain surgery is always the same. Depending on the location of the tumor, the person affected is positioned accordingly and the head is fixed. The patient is put under anesthesia to open the skullcap. If the person concerned is to be awake during the brain operation, the anesthetist ensures that the patient comes to consciousness after the opening, but is free of fear and pain. If the patient stays awake during the brain operation, a neuropsychologist will accompany him during the entire operation time.

When the brain has been surgically exposed, the surgeon attaches electrodes to localize important centers for language, motor skills, muscles, vision and hearing. The tumor is targeted under microsurgical conditions. Imaging processes, fluorescence, computer images and neuromapping support the delicate work of the surgeon. If the tumor is difficult to distinguish from healthy tissue, the patient receives a small current pulse via the electrodes and is asked to do a test. If the brain tissue is healthy, the current causes brief deficits in, for example, motor skills or speech.

If it is tumor tissue, it no longer fulfills a function and the surgeon can better assess the limit and reduce the risk of surgery. After hemostasis and an imaging check, the three meninges and the skull are closed. The patient is transferred to a neurosurgical monitoring station, where he wakes up after the anesthesia.

 

 

Are there any risks involved in brain surgery?

Like any surgery, brain surgery is different Risks connected. In addition to the general risk of surgery and anesthesia, however, an intervention on the brain harbors other dangers: Bleeding can lead to severe neurological failures and permanent damage to motor skills, language, cognition or hearing.

Likewise are Injuries to healthy brain tissue never to be excluded. These traumas also rarely heal without acute impairments, which in the worst case can become chronic. Often the course of a brain operation can be interrupted by one or more epileptic seizures. People who are completely under anesthesia do not notice this. If the operation on the brain takes place in consciousness, some sufferers associate these attacks with fears of death.

It is not uncommon for people to not have processed this fear years later, which can manifest itself in nightmares, flashbacks or panic attacks. Due to the perception during waking operations, it can occur after a brain tumor operation Changes of character come. In some cases, patients feel frightened by the failure symptoms during the operation and have the feeling of heteronomy and of being at the mercy. It is possible that this will result from these sensations as well Psychoses develop.

 

Surgery brain and the cost

Whether it is the cost of a brain tumor operation, a shunt system or a Parkinson's implant - the statutory health insurance in Germany assumes all costs for the insured person in connection with the treatment.

 

Recovery and rehab after brain surgery

The condition after a brain operation becomes continuously monitored. The result of the operation can also be determined by CT or MRI within the first 48 hours. If the condition after the brain operation allows, the patient can go to a general neurosurgical ward on the first day. In many cases, the intracranial pressure is controlled for a few more days using a special tube.

The length of time spent in hospital after brain surgery depends on many factors. With an uncomplicated course and good genesis, the patients can roughly go to the clinic after a period of recovery after the brain surgery 7 to 10 days leave again.

Rehabilitation after brain surgery is definitely recommended. This can be done on an inpatient, outpatient or partial inpatient basis. If it was a malignant brain tumor, it is oncological or neurological-oncological rehabilitation intended for all other types of brain surgery, admission to a neurological rehab facility. The focus is primarily on the therapy of mental deficits, motor impairments, paralysis, balance, hearing and language disorders after a brain operation as well as physical strengthening and psychological processing after cancer treatment. In modern rehabilitation centers, doctors, physiotherapists, occupational therapists, speech therapists, psychologists and social workers work closely together to ensure that those affected can return to life autonomous life to enable.

Rehabilitation can either be done directly as a Follow-up treatment start within 14 days after discharge from the hospital or as curative treatment after completion of chemotherapy or radiation therapy. It is advisable to contact the Social service of the respective hospital to turn. This can provide information about the best clinic after a brain tumor operation, which rehabilitation center is suitable after a meningioma operation and how patients can reach a good rehabilitation clinic after a brain operation.

 

Conclusion

A brain operation is a highly complex treatment that requires a great deal of experience on the part of the surgeon and good preparation of the patient. In a multidisciplinary team, the operation on the brain is carried out with the help of CT, MRI, neuromapping or stereotaxic. But despite very good preparation and professional OP support, changes in personality are possible after a brain tumor operation and the general condition after the brain operation cannot be assessed. Every brain operation involves risks, but acute failure symptoms in particular can be treated as part of rehab.

The best clinic for a brain tumor operation, as well as a good rehabilitation clinic after a brain operation in your area, can be found in a comparison portal.

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