Neurological surgery experiences vary, depending on the type of surgery being performed and why it is being performed. Knowing what to expect can make patients feel more comfortable about an upcoming neurological procedure, and patients are encouraged to talk with their surgeons about the procedures the surgeon will use and what will happen during the surgery. The surgeon should also discuss the risks of the surgery; surgery on the brain and spinal cord is especially risky because it can be associated with paralysis, brain damage, and other major complications.
Before the surgery takes place, the patient will usually undergo extensive testing. The tests include tests ordered by the anesthesiologist to confirm that the patient is a good candidate for surgery, and medical imaging studies to get recent images of the area of interest so that the surgeon is prepared. Patients will also usually be interviewed about allergies, past medical problems, and any other issues which could complicate the surgery. Patients are usually directed to avoid drinking or eating for several hours in advance of the procedure, for safety.
On the day of the neurological surgery, the patient will need to come to the hospital and change into a hospital gown, removing all jewelry. The patient's head may be prepared by shaving, depending on the type of procedure and the preference of the surgeon. Patient are given a sedative to relax while intravenous lines are attached to provide quick access to the patient's venous system if there is a problem. If the patient is going to be anesthetized, he or she will be intubated to create a secure airway, and monitors will also be attached to track the patient's blood pressure, temperature, and heart rhythm.
During the procedure, the surgeon will make an incision to access the area of interest, performing the surgical procedure and then closing the incision. In an awake craniotomy, the patient is asleep while the brain is exposed, and the anesthesiologist wakes the patient up for the procedure, using local anesthetic to control pain. Awake craniotomies are performed when a surgeon is concerned about damaging the brain during a neurological surgery; because the patient is awake, his or her mental status can be constantly evaluated to check for complications and identify areas of the brain which need to be left alone. After the neurological surgery is complete, the patient is anesthetized again so that the incision can be closed.
In some neurological surgeries, it is necessary to use a headframe to stabilize the patient's head during the procedure. In these cases, the patient is anesthetized or sedated while a headframe is put in place, and then brought into the operating room for the procedure. In radiosurgery on the brain, no incisions are made, which means that the patient stays awake, and areas of interest are targeted with radiation. The patient may be given sedatives to stay relaxed during the procedure.
Surgeons know that getting neurosurgery can be scary for patients, and they are usually happy to talk with their patients about the procedures they are performing and what will happen during the procedure. Children and adults alike can benefit from a brief conversation with the surgeon before the procedure to make the neurological surgery more familiar and less frightening.