Consumer Information

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.

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 medications. 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. The hair in your head may be shaved or some of it removed. Soap and water will be used to clean your head and sheets will be put over you. Your head will be placed in a clamp to hold it in position. Caregivers may give general or local anesthesia to make you comfortable during surgery. An endotracheal tube (ET) connected to a breathing machine may be put into your mouth or nose. The tube is used to keep your airway open and help you breathe during your surgery.
During your surgery, you may be asleep or awake. Your caregiver will first 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 will be done using small electrodes placed on the head to test different brain areas.
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 glioma may be removed using an endoscope or other small tools. After removing the glioma, samples of the tumor are sent to the lab for tests. You may receive chemotherapy where wafer-like medicines are placed in the tumor bed to kill other cancer cells. The openings and incisions are then closed with stitches and staples. A bandage is placed over your incisions and around your 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.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

You cannot make it to your appointment on time.
You have a fever (increased body temperature).
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.

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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