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. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. 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.
  
  
• 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: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• 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: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
    
    
  • Local anesthesia: This is medicine to make you more comfortable during your procedure or surgery. It is a shot of medicine put into the skin. It is used to numb the area and dull your pain. You may still feel pressure or pushing during the procedure or surgery after you get this medicine.
  
  
• 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: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
  
  
• Medicines: You may need any of the following:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Anticonvulsant medicine: Anticonvulsants are given to control seizures.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • 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. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
    
    
  • 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, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
    
    
  • Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
    
    
  • Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check your eyes, your memory, and how easily you wake up. Your hand grasp and balance may also be tested. This helps tell caregivers how your brain is working after an injury or illness. You may need to have your neuro signs checked often. Your caregiver may even have to wake you up to check your neuro signs.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
  
  
• 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).

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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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