Brain surgery can only be performed by a neurosurgeon. The surgery is extremely delicate and complex, and used to be very dangerous. Thankfully, with the addition of modern anesthesia techniques, the operating microscope, image guidance (computer assistance to locate brain structures), and other advances, brain surgery has become much safer. Brain surgery usually involves the following steps:
- Prior to surgery, the patient may have a CT or MRI scan, which will be linked with the computers in the operating room.
- General anesthesia is usually administered, however a few brain operations are performed with the patient sedated, but awake.
- The patient's hair in the region of the surgery may or may not be shaved. The patient's scalp is cleaned and prepared for surgery. This area is draped off in a sterile fashion.
- An incision is made through the scalp and plastic clips are placed in the scalp's edges to stop vigorous bleeding.
- Holes are created in the skull with a very high-speed drill. The holes are connected with a foot-plated router attached to the drill. A window of bone is removed and kept in antibiotic soaked sponges.
- The bag of fluid ("dura") in which the brain is contained is carefully opened, exposing bone underneath.
- Depending on the surgery required, the brain is either entered or retracted to reach the problem area.
- An operating microscope is often brought in to assist.
- Computer systems linked to MRI or CT images of the patient's brain are often used to help locate the problem area.
- The problem area is addressed.
- Once the principal part of the surgery is complete (the tumor is removed, for example), the area where the surgery occurred is washed out with antibiotic containing fluid, and is lined with anti-bleeding materials.
- The bag of fluid is closed over the brain.
- The skull is replaced and secured with small metal plates and screws.
- The scalp is closed up and dressed in a sterile fashion.
- The patient is awakened from surgery and goes to a surgery recovery room or the ICU.
Surprisingly, recovering from brain surgery is not very painful. Nonetheless, patients always spend at least one night recovering in the intensive care unit for close monitoring. Either the day after surgery or later in their hospital stay, patients will often have another CT scan of the brain. Patients are mobilized rapidly after surgery to help prevent blood clots and pneumonia. Some patients may spend further recovery time in a rehabilitation facility, if necessary.