The time required for a surgical intervention on a brain tumour depends on several factors. The operating time varies in function of: the type of anaesthetic given to the patient (longer if the patient is awake); the technological resources employed (longer if neurophysiological records, neuronavigation, intra-operative MRI, etc. are used); the type and location of the tumour (more time is required if the tumour is located in functional or deep areas of the brain); and whether or not the patient is awake (longer based on the surgical time and aggression). Generally speaking, operations on brain tumours tend to last an average of 6–7 hours, but in exceptional cases they can last over 12 hours.
Scientific studies have demonstrated that completely shaving your hair off does not reduce the, already very low, rate of infections. Therefore, in general, patients do not have to shave their hair off before surgery. The ring of skin that later corresponds to the surgical wound is normally shaved once inside the operating theatre. From an aesthetic and psychological point of view, this is better for the patient.
Surgery has become an almost inevitable part of brain tumour management, either as a treatment or a diagnostic tool. Surgery is usually the first step and can only be avoided under certain circumstances in patients with a poor overall state of health or those with inaccessible or inoperable tumours.
Even though the surgeons remove the entire mass that was observed during imaging tests, there could still be some microscopic areas of residual tumour, which means it could reappear in the future. The chance of recurrence is higher if the tumour is only partially resected. That is why an adjuvant therapy, e.g., chemotherapy or radiotherapy, must often be used, in function of the tumour’s name and surname.
All possible means will be used during surgery to ensure any post-operative sequelae are kept to a minimum. Nevertheless, there is still some risk. If there are any aftereffects, in most cases patients recover by following a good rehabilitation programme. It will also depend on the patient’s age and the severity of the damage. The recovery time for any nervous system injury is generally between 6 and 12 months. If the sequela is still present after a year, then it may be permanent.
Surgery is carried out with the patient awake when the tumour is located in an area associated with language or whenever the aim is to preserve some brain function that requires the patient remains awake so the area can be explored during the operation. In these interventions the patient is normally only fully conscious when the tumour is being removed (cerebral phase). The patient is completely sedated during the opening and closure, and the skin, muscle, bone and meninges are numbed with a local anaesthetic. Brain tissue does not have pain receptors and so patients do not feel any pain when it is being stimulated. This type of operation is highly standardised. But patients must still possess a series of psychological qualities to overcome the operation successfully.
The chemotherapy and radiotherapy used to treat brain tumours is usually well tolerated, even though some regimens use more aggressive chemotherapy agents. Patients do not tend to lose their hair during these therapies and there are very few side effects, but regular blood and medical tests are still necessary.
If the tumour grows back within an acceptable period and the growth is in a resectable area, then a further surgical intervention may be considered. Sometimes part of the tumour cannot be removed during the first operation; however, later it may be possible to resect the area safely thanks to something called neuronal plasticity (neurons have the capacity to assume the function of other neurons that are suffering damage).
Travelling in a plane represents a problem after a craniotomy as there is normally some residual air trapped inside the skull. Even though it is pressurised, the pressure inside an airplane cabin is still lower than in the take-off area. Therefore, upon take-off, any air contained within in a confined space tends to expand; the consequences could be fatal if this occurs inside the skull. Typically, any post-operative air needs at least 3 weeks to reabsorb and then air travel will not pose any problems.
If the operation goes without any complications, then patients normally have to stay in intensive care for 24 hours, followed by 2 or 3 weeks of convalescence (with a very low level of activity, balancing time between walking, sitting and resting in bed). After the third week, patients can consider a progressive return to their normal lifestyle. Patients are advised against intense physical exercise for at least the first 6 weeks after the intervention.