Open Brain Surgery With Chemotherapy For Malignant Glioma

WHAT YOU SHOULD KNOW:

  • Open brain surgery with chemotherapy for malignant glioma is done to remove a tumor (lump) from the brain. 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 cancer. 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 an open brain surgery or craniotomy, you may either be asleep or awake. Caregivers will do a craniotomy by drilling a hole or removing a part of the skull to expose the brain. During the surgery, brain mapping may be done to check the activities in the different areas of the brain. These include areas of the brain used for speaking, moving, seeing, smelling, and understanding.

  • Your caregiver may also need to do stereotaxy to remove your malignant glioma. 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 remove the glioma more accurately. Chemotherapy is medicine used to treat cancer. During surgery, wafer-like chemotherapy medicine will be placed in your brain. These medicines will help kill cancer cells that may have spread to other areas in the brain. You and your caregiver will decide if this type of surgery for your malignant glioma is right for you. With open brain surgery with chemotherapy, the malignant glioma may be removed, and the symptoms it causes relieved.

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:

  • Problems may happen during your open brain surgery with chemotherapy that may lead to more surgery. Your brain, eyes, other bones and organs, blood vessels, or nerves may get injured while having the surgery. You could also have trouble breathing, an infection, or too much bleeding after surgery. Chemotherapy medicine used in this surgery may cause fatigue (tiredness), diarrhea (loose, watery stools), hair loss, vomiting (throwing up), and headaches. Even after having surgery, there is a chance that your tumor may not be completely 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. A blood clot in your brain can cause a stroke. These problems can be life-threatening.

  • Without treatment, a malignant glioma may 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, 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 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.

  • An IV 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.

  • Anesthesia:

    • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

    • Local anesthesia is medicine used to numb an area of your body that will have surgery or a procedure. The medicine may be given in an injection, cream, gel, or patch.

  • Endotracheal (ET) tube: An endotracheal tube may be put into your mouth or nose. It goes down into your windpipe to help keep your airway open and help you breathe. It may be hooked to a ventilator (breathing machine), and you may get extra oxygen through your ET tube. You will not be able to talk while the ET tube is in place.

During your surgery:

  • The hair on your head may be shaved, or a special strip may be applied to remove strands of hair. Soap, water, and antiseptics will be used to clean your head. Sheets will be put over you to keep the surgery area clean. Special tests may be done to measure the activity of your brain during the surgery. These tests may include an ultrasound, electroencephalogram (EEG), magnetic resonance imaging (MRI) scan, or somatosensory evoked potentials (SSEP).

  • During your surgery, you may be asleep or awake depending on what you and your caregiver have decided upon. Your head will be placed in a special clamp to hold it in position. Your caregiver will make an incision (cut) in your scalp. Special drills may be used to open or make a hole in the skull. A piece of bone is then lifted out and the coverings over the brain are removed. If you are awake during the surgery, brain mapping may be done before and after removing your glioma. If you are asleep, caregivers may remove the ET and wake you up to do the brain mapping. Brain mapping is done using small electrodes placed on the head to test the different brain areas. Caregivers may need to ask you to move your limbs or answer questions to record your brain activities.

  • Once brain mapping is done, stereotaxy may be used to remove your tumor. Caregivers will use a probe (wand-like device) to search for the exact location of your glioma. The malignant glioma may be removed using an endoscope (tube with tiny video camera) or other small tools. After removing the glioma, samples of the tumor are sent to the lab for tests. You may receive chemotherapy medicine. This medicine is wafer-like, and is placed in the tumor bed to kill other cancer cells. The openings and incisions are then closed with stitches and staples. Sometimes, caregivers may also use metal plates or screws to reattach the removed part of the skull. A bandage is placed over your incisions and around the head 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.

  • 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.

  • You will be 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 foods easily, you may slowly begin to eat solid foods.

  • A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

  • 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.

    • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

    • 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.

  • Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

  • Oxygen and a ventilator: You may need extra oxygen when waking up and for a day or two after surgery. Caregivers may leave an endotracheal tube (ET tube) in your throat. Oxygen can be given through the ET tube by a breathing machine called a ventilator. After the ET tube is taken out, you may still need oxygen. The oxygen may be given through a plastic mask over your mouth and nose. Oxygen may also be given through nasal prongs (short, thin tubes in your nose).

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.

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