Your Surgery Guide
Information about Your Craniotomy or Biopsy for a Brain Tumor
To help guide your expectations for surgery, we have put together a summary of surgery steps and resources. If you have additional questions, please feel free to call your physician at (310) 423-7900.
Be sure to tell your surgeon if you're currently on anti-coagulation or blood-thinning medication such as Aspirin, Warfarin, Heparin, or Coumadin. In general, these medications should be discontinued 5-7 days prior to scheduled surgery. Your surgeon will advise you about this.
The Night Before
DO NOT eat or drink anything, including water, after midnight the night before you have surgery.
The Morning of Surgery
If you've been told to take any medication, take it with just a sip of water.
When You Come to the Hospital Please Bring the Following:
- A list of medication you are taking, and a description of how much and how often you take it. (Do not bring the medications with you.)
- Glasses, hearing aids, dentures, a robe, slippers, etc. You'll want to be as comfortable as possible during your hospital stay.
- The telephone number for someone we can contact in the event of an emergency.
- A copy of your advance directives.
Please leave valuable items such as jewelry, credit cards, wallets, or watches, at home. If you bring any valuables with you, we'll ask you to deposit them in our vault. You can re-claim them when you leave.
Self-donated blood or directed donor blood should be donated 72 hours (3 days) before surgery. Ask you doctor for more information, and call the Cedars-Sinai Blood Bank at (310) 423-5347 to set up an appointment for your donation.
If you have any additional questions, please don't hesitate to call us at (310) 423-7900.
On the Day of Your Surgery
The day of your surgery has arrived and naturally you are concerned, and maybe even a little scared. It might help put your mind at ease to learn a little about what will happen during the course of your surgery.
How Surgery Begins
After you've been admitted, you will be taken to the "pre-op" area, where you'll meet with doctors and nurses who will ask some questions about your medical history. They will answer any new questions that you may have about your hospital stay. Your Anesthesiologist will introduce him or herself at this time and explain how the anesthesia will affect you.
A nurse will then start an intravenous (IV) fluid drip in your arm vein. This IV. will continuously provide water and nutrients to your system to keep you hydrated. But the I.V. has another purpose as well. It allows the team to administer many different medications through one source rather than having to give you a separate injection each time a new medicine is needed.
The Operating Room
Once the I.V. is in place, you'll be taken to the operating suite where you'll be moved to the operating table and given the anesthesia. After you go to sleep, a tube will be inserted through your mouth and the bronchial tube leading to your lungs so to help you breathe more easily during surgery. This is called "intubation."
You'll also have a catheter inserted into your bladder to allow urine to flow into a collection bag while you sleep. The catheter may remain in place after the surgery for a time, until you can move around and urinate on your own.
Before the operation begins, your head will be positioned in a device called a "Mayfield." It's a fancy name for a brace that holds your head steady during surgery. Once you're in position, you won't be moved again until after surgery.
If your operation is for a tumor, its specific location is identified by using sophisticated computer guidance imaging techniques. Then your head will be cleaned with an antimicrobial soap, and depending on the tumor location, a small area of hair will be shaved.
If your operation is for removal of a tumor, your doctor will remove a small sample of the tumor and a pathologist - a doctor who specializes in evaluating diseased tissue -- will study the specimen under a microscope to see which type of cells are present. Unfortunately, the pathologist is only able to make a preliminary assessment. The sample will need to be sent to the laboratory for final analysis and diagnosis, which generally takes 5 days.
When the surgery is finished, you will be moved to a recovery area where you will remain until you awaken. Your head may be wrapped in a turban-like dressing, and typically both your anesthesiologist and neurosurgeon will be there. After evaluating your status, family members will be permitted to visit.
After Surgery...What to Expect
Immediately following surgery you'll be taken to the recovery room, where (vital) functions will be watched closely. While here, your family will be allowed to visit for short periods of time.
During this time, your room in the neurosurgical intensive care unit (ICU) will be prepared. Once it's ready, you'll be moved in and a team of doctors along with the Nursing and support staff (will assist your surgeon) with your general care.
The ICU team is comprised of an intensivist (a physician who specializes in critical care), medical residents, critical care nurses and a highly-trained group of "Residents" or "Fellows" (licensed doctors who are receiving advanced training in neurosurgical care).
Your stay in the ICU will probably last about twenty-four hours, depending on the progress of your recovery. When you're ready to leave the ICU, you'll be transferred to an inpatient nursing unit, where the rooms are larger and there is less monitoring equipment. While here, your family members will be allowed to spend the night with you in your room if you wish.
In your new room, you'll be cared for by many different staff members who work together as a team to assure a full and speedy recovery. Each member of the staff involved with your recovery attends weekly meetings as well as daily rounds to ensure continuity in your care. This team is composed of:
- Registered nurses (RNs)
- Physical and occupational therapists who will work with you to help strengthen your muscles, regain your balance and become more physically able
- Speech therapists may need to help you regain your cognitive, communication and swallowing skills.
- Psychologists are available to help you cope with the emotional and physical changes you may experience.
- Social workers to help you and your family adapt to any changes in your family life, career, social life and financial circumstances.
These skilled professionals will assess your needs and help you to decide whether home care is sufficient. They'll explain transportation and employment options, offer referrals for other services, and assist in planning follow-up care.
Additional support staff may include:
- Psychiatrists and neuro-psychologists who specialize in testing memory, thinking and reasoning processes.
- Case managers, who are nurses assigned to oversee your transition from the intensive care setting, through recovery and into discharge planning
What to Expect after your Discharge from the Hospital
Leaving the hospital after surgery can be both comforting and frightening. It's comforting because you are going back to the familiar safety of your home. It's frightening because you're not sure what to expect. Remember that you're not alone, and that it's OK to rely on family and friends for help.
Typically, discharges occur in the morning. On the day you leave the hospital your doctor, resident or physician assistant will see you. This is the time to ask any questions about what to expect over the next several days, and to get advice on home care. During this time, you will be given a detailed plan that will include:
- Caring for your wound
- Recommended and prohibited activities
- Medication and dosage information
- What to do if you have a problem
You will need to call the Department of Neurosurgery at (310) 423-7900 to obtain an appointment for follow-up.
A Few Important Things to Remember:
Arrange to have transportation from the hospital on the day you are discharged. The hospital does not provide transportation. We recommend you contact your insurance company to explore your coverage for transportation. Insurance may cover the cost if you cannot walk and/or your medical condition requires you to be transported lying down.
There are medical vans available through community agencies. They are generally the least expensive form of transportation, but you will have to contact specific agencies to confirm cost. Payment is required at time of service. Taxis are also available if you can be transported in a sitting position, and the cost is based on the distance traveled.
If you have a concern about transportation, contact the Department of Neurosurgery Social Worker at (310) 423-7900.
Arrange for child care if you have small children
If you have young children you may not be able to look after them immediately after your return home. Make sure that you have a child care plan in place so that you can get the rest you need.
Make sure there's someone at home who can help you
Initially, it is recommended that you have someone stay with you most of the time until you feel stronger and are able to tend to your own needs. If you do not have someone who can assist you at home, an attendant can be hired through a community agency. Usually insurance does not cover this cost.
Once you're home, if you have additional questions or concerns, please do not hesitate to call us at (310) 423-7900. A knowledgeable staff member will be happy to answer your questions.