Brain surgery, also known as neurosurgery, is considered major surgery. This is because the brain is a vital organ and operating on it carries significant risks.
What makes a surgery “major”?
Major surgery refers to any invasive operative procedure in which a more extensive resection is performed, organs are removed, or normal anatomy is altered. Some key factors that classify a surgery as major include:
- Extended operation time, usually over 90 minutes
- High blood loss risk requiring transfusions
- Large incisions rather than keyhole/laparoscopic methods
- General anesthesia and intubation are required
- Overnight hospital stay is needed for recovery
- High risk of post-operative complications
Brain surgery meets many of these criteria and is always considered a major procedure.
Why is brain surgery considered major surgery?
Here are some reasons why neurosurgery is categorized as major surgery:
- Critical organ: The brain is the body’s command center and damage can be catastrophic. Operating on the brain is inherently high-risk.
- Complex anatomy: The brain has delicate blood vessels, neurons, and tissues. Navigating this complex anatomy requires great skill.
- Precision: Even millimeters count in brain surgery. Damage to critical areas can cause paralysis, loss of senses, speech, or cognition.
- Long procedures: Brain operations often last many hours depending on the complexity.
- General anesthesia: Total unconsciousness is required for brain procedures.
- Significant incisions: Opening the skull and cutting into brain tissue involves large incisions.
- Extended recovery: Hospital stay is typically 1-2 weeks with months of rehab. Full recovery can take over a year.
- Risk factors: Brain swelling, bleeding, seizures, stroke, and infection are risks.
Given the sensitive organ, surgical complexity, risks, and aftermath – neurosurgery is deemed major surgery without exception.
Preparation for brain surgery
Extensive preparation goes into planning and performing neurosurgery. Steps include:
- Medical history review for risk factors like bleeding disorders
- Mapping of the brain and vasculature via CT/MRI scans
- Analysing and planning the surgical approach
- Administering steroid medications to reduce brain swelling
- Conducting neurological exams to establish a baseline
- Testing blood counts, electrolytes, coagulation factors
- Psychological evaluation and counseling of the patient
- Informed consent briefing about risks, expectations, and alternatives
- Cautioning against aspirin, alcohol, and medications before surgery
- Assembling a skilled operating team and neuro-ICU care team
Meticulous preparation is vital due to the delicate nature of brain surgery.
Procedures and techniques
Some examples of brain surgery procedures include:
- Craniotomy: Opening the skull to access the brain.
- Tumor resection: Removing benign or cancerous tumors.
- Aneurysm clipping: Placing metal clips on bulging blood vessels.
- Hematoma evacuation: Draining blood clots or hemorrhages.
- Biopsy: Extracting tissue samples for analysis.
- Implantation: Installing medical devices for Parkinson’s, epilepsy, etc.
- Ventriculostomy: Draining cerebrospinal fluid in hydrocephalus.
- Decompression: Relieving pressure inside the skull.
Neurosurgeons use specialized techniques such as stereotactic navigation, neuro-endoscopy, ultrasound, and brain mapping to safely operate on delicate brain regions.
Risks and complications
While rare in experienced hands, brain surgery does carry risks including:
- Infection – meningitis, abscess
- Bleeding and blood clots
- Brain swelling and edema
- Seizures
- Leakage of cerebrospinal fluid
- Stroke or aneurysm
- Loss of neurological function – paralysis, speech, vision, etc.
- Coma or Vegetative state
- Death (1-2% mortality rate)
Cutting into the brain can impact vital systems. Meticulous care aims to avoid complications.
Recovery after brain surgery
Recovering from major brain surgery involves:
- 1-2 week hospital stay with close neurological monitoring.
- Tapering off anesthesia and pain medications.
- Managing wound care and drainage.
- Gradually becoming mobile again while avoiding falls.
- Restarting oral intake and regaining appetite.
- Undergoing speech, physical and occupational therapy.
- Having follow-up appointments to check recovery.
- Taking medications and following treatment plans.
- Getting cleared to resume work and normal activity.
Full recovery can take over a year depending on the procedure. Patience and following neurosurgeon’s advice is key.
Conclusion
In summary, neurosurgery to operate on the brain is universally considered major surgery. The extreme delicacy of the procedure, significant risks involved, extended recovery period, and potential for debilitating complications qualify brain operations as major. Extensive planning, skilled surgeons, and diligent postoperative care aim to ensure successful outcomes after such a serious surgery. Patients considering brain surgery should thoroughly discuss the pros and cons with doctors to make an informed decision.