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IMMEDIATE POST OPERATIVE COURSE
The risks of formal craniotomy are bleeding, infection, stroke, cranial nerve deficit, death, seizure and cerebrospinal fluid leak, just to name some of the risks. Depending on the tumor or the location not all of it may be removed. The patient may have a deficit after surgery. It is either temporary or permanent. After surgery the patient goes to the Intensive Care unit and will be there until recovered. Minimal or complete shaving of hair occurs before surgery. After surgery there may be a drain to get rid of the excess blood or a catheter in the ventricular system to drain excess cerebral spinal fluid. There may be a small dressing or a very large pressure dressing. The swelling of surgery of the front part of the head can lead to temporary complete closure of the eyes. Swelling is treated with ice for several days after surgery. The eyes may still swell shut but will swell for less time and return to normal more quickly. The patient may have a scan after surgery while in the intensive care unit or at sometime later. It is normal to progress slowly, getting out of bed within a day or two of surgery. Even returning to eating may be slow. This is not unexpected and is dependant upon the type of surgery, the size of the mass and your condition after surgery. Chewing may be sore after surgery because the muscles that go to the jaw attach to the side of the head where surgery may have taken place. After the ICU, the patient will be transferred to the general floor prior to leaving the hospital. The patient may then go to rehabilitation, skilled care facility or home. The long-term changes after brain surgery may be headaches, depression, and changes in mood, judgment, memory or behavior. The degree of changes decreases over time and is dependant upon the circumstances of surgery.
ADJUNCTIVE THERAPY
Usually if the patient has undertaken the risk to have surgery and the mass if of a type that is best treated with additional measures, the patient should then undergo these additional measures if they can be performed safely. It is only in utilizing all the additional measures that we call help the patient lead the longest and best quality life. Many times the measures include radiation therapy. Radiation therapy may be to the area of the mass or may encompass the entire brain. Sometimes depending on the tumor type, radiation may also encompass the entire spine. The length of radiation therapy as well as the days of radiation therapy will be discussed with the radiation oncologist. Radiation therapy like surgery has risks. Radiation therapy may lead to brain swelling as well as damage to the surrounding brain. The radiation therapy can either be conventional or stereotactic radiosurgery. Focused beam stereotactic radiosurgery is done with either a Gamma knife or linear accelerator. Radiosurgery acts as a focal destructive boost to the area of the mass.
In addition to radiation therapy brachytherapy can be utilized. This is the implantation of radioactive substances within or near the tumor. This can deliver very high doses of radiation to the tumor, minimizing the affect on the normal tissue. Other types of applied therapy are hyperthermia, hypothermia or cryotherapy, proton beam therapy and boron neutron capture therapy.
Sometimes the mass responds best to chemotherapy and this is best discussed with the oncologist. Chemotherapy is usually delivered through the body in hopes that the drugs will kill off the tumor cells. Sometimes the chemotherapeutic
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