Craniotomy For Excision Of A Cerebral Arteriovenous Malformation

WHAT YOU SHOULD KNOW:

• You may need a craniotomy if your caregiver has told you that you have an arteriovenous malformation (AVM). A craniotomy is surgery to open your skull and operate on your brain. An AVM is an abnormal connection between your veins and arteries. Arteries are blood vessels that bring blood with oxygen to your different body organs. Veins are blood vessels that bring blood without oxygen to your heart. An AVM may be found anywhere in your brain. Normally, blood flows from your arteries, through your capillaries (very small blood vessels), then into your veins. In AVMs, capillaries are absent and blood flows directly from your arteries into your veins.
  
  
• You may have had an AVM since birth or you may have developed an AVM during your life. You may need a craniotomy if your AVM causes your brain to bleed. You may also need a craniotomy if you have symptoms such as seizures (convulsions), headaches, or speech problems. Your caregiver will grade your AVM based on its size, location, and depth. This will help him decide whether a craniotomy is right for you. After a craniotomy, your headaches and other symptoms may decrease or stop. You may also find it easier to move and speak.

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:

• You may get an infection. You may have headaches, eyesight problems, or seizures. You may be allergic to the anesthesia or medicine used during your surgery, or you may bleed more than expected. Your brain and the layers of tissue that cover it may swell. You may need surgery again if some of the abnormal blood vessels were not removed.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. Your AVM may also hemorrhage (bleed heavily) in your brain. If there is bleeding or a blood clot in your brain, you may have a stroke. These problems can be life-threatening.
  
  
• If you do not have a craniotomy, your AVM may rupture and bleed, and cause more symptoms. You may die if your bleeding continues. Call your caregiver if you have questions or concerns about your surgery, condition, 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.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Embolization therapy: Your caregiver may put a substance into the arteries that lead to your AVM. This will block the arteries and stop blood from flowing into your AVM. If your AVM is large, embolization therapy may make its center smaller.
  
  
• Tests:
  
  
  • Angiography: Your caregiver may do an angiogram to check the blood flow in your brain.
    
    
  • Computed tomography scan: This is also called CT scan. A special x-ray machine uses a computer to take pictures of your head. It may be used to look at your bones, brain tissue, and blood vessels. It may show the location of your AVM. It may also show if your blood vessels are bleeding or becoming hard.
    
    
  • Magnetic resonance imaging: This is also called an MRI. An MRI may be used to look at your brain and the abnormal blood vessels of your AVM. During the MRI, you may also have a test called magnetic resonance angiography or MRA. An MRA may be done to see the blood flow inside your AVM. This will help your caregiver see if your blood vessels have areas that are blocked or narrow.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Pre-op care: You may be given medicine to make you feel relaxed and sleepy right before your surgery. You are taken on a stretcher to the room where your surgery will be done.
  
  
  • General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
    
    
  • Monitoring:
    
    
    • 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.
      
      
    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
      
      
    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

During your surgery:

• You are put on a table where your craniotomy will occur. Your position on the table will depend on where the AVM is located in your brain. Sheets are put over you to keep the surgery area clean. A cut is made to open your scalp. Your caregiver carefully drills your skull to make an opening. He then removes a piece of your skull so he can see your brain and AVM. Your caregiver clips or ties the arteries to stop the blood flow to your AVM.
  
  
• Your caregiver may inject a substance to block the arteries. This plugs up the arteries so blood cannot flow into your AVM. Your caregiver then removes the cluster of abnormal blood vessels from your AVM. Your caregiver ties the vein that was attached to the AVM. He makes sure there are no areas that are bleeding inside your brain. Your skull bone is put back in place and the cut is closed with stitches. Your caregiver then covers your stitches with bandages.

After your surgery:

You will be taken to a room where you will rest until you wake up. Caregivers will watch you closely for any problems. Your breathing, blood pressure, and pulse will be checked often. When caregivers see that you are OK, you will be taken back to your hospital room. Do not get out of bed until your caregiver says it is OK. A caregiver may remove your bandages soon after surgery to check your wound.

• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Medicines:
  
  
  • Anti-convulsants: This medicine is given to control seizures.
    
    
  • Antihypertensives: You may receive antihypertensives, which is medicine to lower your blood pressure. Lowering your blood pressure may decrease the pressure in your brain.
    
    
  • Anti-nausea medicine: The feeling that you are about to throw up is called nausea. You may feel nausea or throw up (vomit) after receiving general anesthesia. Nausea and vomiting may cause your brain to bleed because the pressure inside is increased. This medicine may be given to help calm your stomach and help stop you from vomiting.
    
    
  • Barbiturates: This medicine may be used to keep you asleep. You may need to be kept asleep if you have too much pressure in your brain.
    
    
  • Steroids: This medicine may be given to decrease swelling in your brain.
    
    
  • Blood thinners: This medicine helps prevent clots from forming in the blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
  
  
• Tests: After your craniotomy, your caregiver will do tests to make certain that your AVM was completely removed. Angiography may show if there are still abnormal vessels left in your brain. Your caregiver may also do a CT scan of your brain to check for bleeding.

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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.