for acoustic neuroma is performed to remove a benign tumor
from within the brain.
The patient will
be taken to the operating room and put to sleep under general
anesthesia. The head will be partially shaved, to expose
the area of operation, behind the ear where the tumor lies.
The head is then placed in three fixation points (Mayfield
head pins). This provides the ability to keep the head
perfectly still during the procedure. The patient is
turned on their side. The surgeon may register a navigational
device which allows the use of "real time" intraoperative
navigation. The area where surgery is to be performed
is then "prepped and draped" using an antibiotic
solution. Next, the surgeon will make an incision, and
reflect the scalp over the area of the tumor. An air
powered drill is then used to make a hole in the skull, a
drill or rongeur (bone biter) is used to remove a portion
of bone overlying the area of the tumor. The dura mater
(tough covering of the brain) is then opened. An operating
microscope is generally brought into the field, and the surgeon
will approach the tumor within the brain.
Often the edges of the cerebellum (back portion of the brain)
are gently supported using brain retractors. Generally
the surgeon will attempt to remove all of the tumor, or as
much as possible. Any visible bleeding points will be
cauterized. Often, hemostatic promoting material is
gently laid over the surfaces of the brain, and closure is
begun. The surgeon will close the dura, and may
or may not elect to place a covering over the skull.
Possible options for skull replacement are the patient's own
bone, surgical cement, methylmethacrylate ( a type of hardened
plastic), or titanium mesh. Next the scalp will
be closed in layers.
Risks for craniotomy
for acoustic neuroma can be broken down into two categories,
1) those related to the operative site, and 2) those related
to the risks of anesthesia.
related to the operative site
Exposure: The patient is placed in a position
so as to allow the surgeon good access to the tumor.
There is risk of non healing of the scalp post operatively.
Although very uncommon, there can be injury to or tearing
of the scalp from the pins on the Mayfield clamp.
There is the potential for spinal fluid leak postoperatively,
which may require additional surgery to repair.
The surgery involves opening the back of the skull behind
the ear, and gently retracting the cerebellum ( back of
the brain), to expose the tumor. There can be damage
to the cerebellum, brainstem, and cranial nerves (nerves
leaving the brainstem and providing functions such as hearing,
facial movement, and facial sensation). These tumors
generally arise from the nerves supplying balance (vestibular
nerves), and the tumors are usually adherent to the nerve
supplying hearing and facial movement. Depending upon
the size of the tumor, hearing may be lost (if not already
lost due to the tumor prior to surgery) due to surgery,
and facial function may be completely lost on the side of
the face where the tumor is located. Sometimes the
facial function will return if the nerve has only been bruised
but is anatomically intact. If there is brain
injury, this could result in weakness, seizures, stroke,
paralysis, coma or death. There may be residual fluid
or blood, requiring additional surgery in the future.
There is a possibility of tumor remaining after surgery,
or of recurrence of tumor in the future.
such general difficulties, such as bleeding, infection,
stroke, paralysis, coma and death. Incisions on the
scalp generally heal well, but could become tender,
numb, or may heal in an unpleasant manner. If
there is hearing loss preoperatively, generally this will
not improve with surgery, and may in fact worsen, resulting
in deafness. Balance problems may not improve, and
may worsen. The tumor may recur, requiring additional
surgery or radiation in the future. In addition, although
every attempt is made to protect all areas of the body from
pressure on nerves, skin and bones, injuries to these areas
can occur, particularly with prolonged cases.
Anesthesia: Blood clots in the legs, heart attacks,
reaction to the anesthetic, reaction to blood transfusion,
if it given
There is surprisingly
relatively little pain associated with craniotomies.
Your surgeon will prescribe pain medications for any pain
associated with the incision.
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been set up.
- Take it easy
until seen by the physician. This does not mean bed
rest, but athletic activities during this period are definitely
not recommended. Please give your incision a chance
to heal. Avoid any type of activity which might risk
a blow to the head.
- You may resume
activity as your body permits, but avoid extremes.
For example, walking is fine, but avoid any strenuous running.
USE GOOD JUDGMENT AND COMMON SENSE. If you have
a question, ask your doctor.
- No driving
until cleared with your surgeon. A driving test may
be required, at the discretion of your surgeon. Even
though you may feel fine, your peripheral vision and reflexes
may have been affected, and we want you to be safe on the
road for yourself as well as for others.
- You may shower
after you go home unless otherwise instructed. Cover
the incision with plastic wrap before the shower and remove
it afterward. Change dressing immediately.
You may shower without covering the incision one week after
the staples are out. Follow instructions concerning
care of tapestrips, stitches or staples. Your surgeon
or his nurse clinician will explain the techniques used
in the closure of your incision.
- Sexual activities
- If you notice
swelling, redness or opening of the incision, or if there
is any clear fluid draining from it, please contact your
surgeon immediately! If you develop a fever, stiff
neck or chills, contact the office immediately. Take
your temperature at 4:00 PM daily until the clips are removed.
Call if greater than 101 degrees Fahrenheit.
- If you have
a seizure, notify our office or come to the emergency room.
- If you develop
any new weakness, notify our office.
- If you have
any paralysis or weakness, post-operative care will need
to be tailored to this. If a brace for an arm of a
leg has been prescribed, use it as recommended by your surgeon.
- If you have
any questions, call our office, and for after hours emergencies,
call the medical society.
- Take your
medications prescribed on discharge, as directed.
- Do not take
any medications which will "thin the blood" such
as coumadin or aspirin, or other non-steroidal antiinflammatory
medications, unless otherwise advised by your physicians.
- Make sure
to follow up with any other physicians involved in your
care. These may include your family physician, neurologist,
radiation oncologist and oncologist.