Closed Stereotactic Surgery For Malignant Glioma

WHAT YOU SHOULD KNOW:

• Closed stereotactic surgery for malignant (mah-LIG-nant) glioma (gli-O-mah) is done to perform a biopsy on a tumor (lump) in the brain. A small piece of the tumor is taken out during a biopsy and sent to a lab for tests. The brain is made up of neurons which transmit and receive signals, and glial cells which support and nourish neurons. A malignant glioma forms when glial cells become cancerous. The glial cancer cells grow and divide without control or order. These cancer cells often make too much tissue and affect other nearby structures in the brain. During closed stereotactic surgery, the head will be placed on a head frame that is connected to a computer. This will guide your caregiver to the exact location of your tumor while doing the biopsy.
  
  
• Once the head frame is attached, caregivers will need to do stereotaxy. In stereotaxy, scanned images of the brain will show pictures in three-dimensional (3-D) views. This will help caregivers clearly see the different brain areas while watching the images in a monitor. Stereotaxy may enable caregivers to target and biopsy your glioma more accurately using a special needle. You and your caregiver will decide if this type of surgery for your malignant glioma is right for you. With closed stereotactic surgery, biopsy of the malignant glioma may be done and proper treatment may be given.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• During the closed stereotactic surgery, your brain, eyes, bones, blood vessels, or nerves may get injured. You could have trouble breathing, an infection, or too much bleeding after surgery. Problems may also happen while doing the closed sterotactic surgery that may lead to an open brain surgery. Even after having surgery, there is a chance that another biopsy may have to be done.
  
  
• Without this surgery, the extent of the malignant glioma may not be known and proper treatment not be given. The tumor may continue to grow and push other structures near it. If this happens, there is a danger that the blood or nerve supply may be cut off. You may have problems seeing, moving, speaking, breathing, or thinking clearly. This may lead to other serious medical problems, such as blindness, seizure (convulsion), or stroke. Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Local anesthesia: Medicine is used to numb the area of your body where the surgery or procedure will be done. It is usually injected into the skin. It also may be given as a gel or jelly applied to your gums for dental procedures or as a patch. For such areas as the genitals, medicine may be given as a cream on the skin or mucus membranes.

During your surgery:

• The hair on your head may be shaved. Soap, water, and antiseptics will be used to clean your head. Sheets will be put over you to keep the surgery area clean. Caregivers may give general or local anesthesia to make you comfortable during surgery.
  
  
• During your surgery, pins or screws are inserted on your scalp where the rigid head frame is attached. An incision (cut) is made on your scalp and a small opening is drilled in your skull. Using stereotaxy, your caregiver will insert a special needle into the incision and through the small opening. The needle passes through your brain until it reaches the exact location of the tumor. The hollow needle will get a small piece of the tumor, and the samples are sent to the lab for tests. The pins or screws are loosened and the rigid frame removed from the head. The small incision is closed with stitches (threads), and a bandage is placed over them to control bleeding.

After your surgery:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound. Ask your caregiver for more information about ways to prevent bleeding and take care of your wound.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Food and drink after surgery: You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Diuretics: You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • Prednisone: This steroid is often given with other chemotherapy medicines. Prednisone may help shrink lymph nodes back to their normal size. It can also help control the number of leukocytes, which are a type of white blood cell. Do not stop taking this medicine without your caregiver's OK. Stopping on your own can cause problems.
  
  
• Monitoring: Caregivers may check for your pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.