What are the other Names for the Procedure?
- Craniotomy for Tumor of Meninges
What is the Craniotomy and Excision of Tumor surgical procedure?
- A craniotomy procedure involves making a hole in the skull by removing a portion of the bone (bone flap). This may be done for various reasons, tumor removal being one of them
- After the tumor has been removed, the surgeon replaces the bone flap
What part of the Body does the Procedure involve?
A Craniotomy and Excision of Tumor procedure involves the skull, the tissue covering the brain called the dura, and the brain.
Why is the Craniotomy and Excision of Tumor surgical procedure Performed?
The Craniotomy and Excision of Tumor procedure is performed for the following reasons:
- To obtain a sample of tumor for tissue diagnosis
- Tumor removal
What are some Alternative Choices for the Procedure?
There are usually no alternatives to the procedure. Enquire with your physician about the possibility of using drugs (chemotherapy) and/or radiation for treatment of the tumor.
What are the Recent Advances in the Procedure?
Minimally-invasive techniques involving the use of an endoscope (a tube fitted with a camera) have been developed to perform the procedure.
What is the Cost of performing the Craniotomy and Excision of Tumor surgical procedure?
The cost of Craniotomy and Excision of Tumor procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding an Craniotomy and Excision of Tumor procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/brain_tumor/treatment/surgery/craniotomy.html (accessed on 05/09/2015)
http://www.abta.org/brain-tumor-treatment/treatments/surgery.html (accessed on 05/09/2015)
Prior to Craniotomy and Excision of Tumor surgical procedure:
How is the Craniotomy and Excision of Tumor surgical procedure Performed?
The Craniotomy and Excision of Tumor procedure may be performed under general anesthesia.
- Depending on the location of the tumor, the surgeon makes a skin incision on the corresponding region of the head. The scalp is separated from the underlying bone
- Using special instruments the surgeon makes holes in the skull and removes a flap of bone
- The tissue covering the brain (dura) is cut open to gain access to the brain tissue
- The surgeon removes the tumor, taking care to avoid damage to nearby healthy tissue
- Once the tumor has been removed, the tissue layers are set in place and the bone flap is replaced using wires or plates
- The skin incision is closed
Where is the Procedure Performed?
A Craniotomy and Excision of Tumor procedure is performed in a hospital.
Who Performs the Procedure?
The procedure is performed by any of the following medical personnel, with or without assistance from an anesthesiologist:
- A neurosurgeon
How long will the Procedure take?
The procedure may take 3-5 hours to perform.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Craniotomy and Excision of Tumor procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Craniotomy and Excision of Tumor procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Craniotomy and Excision of Tumor surgical procedure?
Before a Craniotomy and Excision of Tumor, the patient has to undergo certain tests such as:
- MRI or CT scan of the head
- Chest X-ray
- Routine blood and urine analysis
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is Craniotomy and Excision of Tumor?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
- What are the costs involved?
During the Craniotomy and Excision of Tumor surgical procedure:
What kind of Anesthesia is given, during the Procedure?
General anesthesia by injection and inhalation is administered for this procedure.
How much Blood will you lose, during the Procedure?
Slight blood loss during an uncomplicated Craniotomy and Excision of Tumor procedure may be expected.
What are the possible Risks and Complications during the Craniotomy and Excision of Tumor surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Craniotomy and Excision of Tumor surgery are:
- Excessive bleeding
- Infection within the surgical wound
- Anesthetic complications
- Leakage of cerebrospinal fluid
- Accidental injury to the brain leading on to movement disorders, weakness, memory-related problems, etc.
What Post-Operative Care is needed at the Healthcare Facility after the Craniotomy and Excision of Tumor surgical procedure?
- After the Craniotomy and Excision of Tumor procedure, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
- The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will be treated
- Individuals are usually discharged from the hospital within 3-7 days of the procedure, if there are no complications
After the Craniotomy and Excision of Tumor surgical procedure:
What are the possible Risks and Complications after the Craniotomy and Excision of Tumor surgical procedure?
The possible risks and complications that may arise after a Craniotomy and Excision of Tumor procedure are:
- Excessive bleeding
- Infection within the surgical wound
- Accumulation of fluid in the brain
- Swelling of the brain
What is the Prognosis after the Surgery?
The prognosis after a Craniotomy and Excision of Tumor procedure depends on the tumor location, extent, age of the individual, and the presence of other co morbidities.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain and swelling around the surgical wound
- Bleeding or fluid drainage from the surgical wound
- The occurrence of any symptom that causes uneasiness such as nausea, vomiting, abdominal swelling, or constipation
- Signs of an infection
- Headache, muscle aches
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Craniotomy and Excision of Tumor surgical procedure?
At home, the following post-operative care is recommended after a Craniotomy and Excision of Tumor procedure:
- Slowly resume regular/daily activities as early as possible
- Physical therapy, walking, and back and neck exercises should be done as advised
- Avoid lifting of heavy weights
- Avoid actions such as bending the head down too low, straining in the toilet, or coughing too hard. Medications to prevent constipation or prolonged episodes of coughing may be prescribed
- Avoid driving for two to four weeks after the procedure, as advised by your physician
- Resume showering 3-4 days after the surgery, but keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with mild or unscented soap
- Replace the dressings on the surgical wound after showering
- Complete the course of prescribed medication under advice of the physician
- Take antibiotic medication to help combat or prevent infection, per your physician’s advice
- Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)
How long does it normally take to fully recover, from the Procedure?
Recovery from the procedure may take up to 2-8 weeks.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision.
- Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued.
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Craniotomy and Excision of Tumor surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- A hospital
- An anesthesiologist
- A neurosurgeon
- A pathologist
The patient is advised to inquire and confirm the type of billing, before the Craniotomy and Excision of Tumor surgical procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA