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.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medicines. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• You may need to have a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. The images taken may be used in stereotaxy. The scanned pictures will be converted into 3-D images and displayed on a monitor. You may also need other tests, such as chest x-ray, electrocardiogram (ECG), and blood tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  
  
• You may need to stop driving, lifting heavy things, or doing strenuous or tiring activities.
  
  
• Your caregiver may give you steroids and other medicines to use. These medicines help prevent seizures (convulsions) or stomach ulcers (sores). Ask your caregiver for more information about these medicines.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• You may be given a pill to help you sleep.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses on the day of your surgery. You may wear glasses. Wear socks to help you stay warm.
  
  
• If you are staying in the hospital after your surgery, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy during your surgery.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved into a special bed or chair. The hair in your head may be shaved or some of it removed. 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 will be used to securely attach the rigid head frame to your head. Using stereotaxy, your caregiver will insert a special needle into your scalp and skull through a small opening. The needle passes through your brain until it reaches the exact location of the tumor. After getting a small piece of the tumor, the samples are sent to the lab for tests. A bandage is placed over the incision 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 incision.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• You have a sudden severe headache.
  
  
• You have trouble seeing, breathing, speaking, or thinking clearly.
  
  
• You passed out or had a seizure (convulsion).
  
  
• Your face is getting numb or you cannot move your arms or legs.

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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.