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.

Getting Ready

Before your surgery:

• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You may need to have blood tests. Your caregiver may also do a computed tomography (CT) scan or magnetic resonance imaging (MRI). If you have a large AVM, you may need to have a procedure called embolization before your surgery. Ask your caregiver for more information about other tests or procedures that you may need. Write down the date, time, and location of each test.
  
  
• Your caregiver will grade your AVM based on its size, location, and depth. This grade will help him decide whether or not a craniotomy is right for you. Grading will also help guide your caregiver during surgery.

The night before your surgery:

• You may be given medicine to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Caregivers may 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 before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen:

• You will be taken to the room where your surgery will be done. Medicine called anesthesia will be given to keep you asleep and free from pain during your surgery. Your caregiver may put IV lines in you to show how your body is doing during surgery. Your head will be cleaned and sheets will be put over you to keep the surgery area clean.
  
  
• Your caregiver will carefully cut your scalp and drill your skull. He will then remove a piece of your skull so he can see your brain and AVM. Your caregiver will clip or tie the arteries to stop the blood flow to your AVM. He will then remove the cluster of abnormal blood vessels from your AVM. Your caregiver will tie the vein that was attached to the AVM. He will then put your skull bone back in place. Your caregiver will close your cuts with stitches and cover them 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.

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 surgery.
  
  
• You get sick (a cold or the flu).
  
  
• You have a fever.

Seek Care Immediately if

You have signs of a stroke:

The following signs are an emergency. Call 911 immediately if you have any of the following:

• Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
  
  
• Confusion and problems speaking or understanding speech
  
  
• A very bad headache that may feel like the worst headache of your life
  
  
• Not being able to see out of one or both of your eyes
  
  
• Feeling too dizzy to stand

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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.