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Frequently asked questions - Brain Surgery

# Why surgery is needed?

Brain surgery is required for any of the following reasons (list not limited)- reduce the pressure inside the skull, get the diagnosis, prevent regrowth of tumors, facilitate further therapy and recovery, improve pain/disability/fits/convulsions/seizures etc. When a surgeon is ascertained there are no better options available, surgery is recommended, some times as an emergency or other times as semiurgent and/or planned way.

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# What are the options?

Occasionally there are options such as waitful watch, Stereotactic radiosurgery/Gamma Knife surgery/Proton beam therapy, Laser interstitial thermal therapy(LITT), however, the Neurosurgeon is the best person who can decide which is a better option.

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# What is the risk with brain surgery?

Every surgery carries some risk. However, it depends on many factors such as type of surgery, location of tumor, grade of the tumor, extent of the tumor, patients age - associated conditions such as Heart/Kidney/Lung ailments, experience and skill of the surgeon and the team, tools/gadgets available etc. At our centre, the risks are minimised to as low as possible, due to the well established skill set of the surgeon and his team (Dedicated Neuroanaesthetists,Neurophysiologist, Neuointensivists, Neuroradiologists, Interventional Neuroradiologist, Neurorehabilitation) along with availability of latest world class technology. Every attempt is made to adopt minimally invasive key hole approach.

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# Will I get paralysed? Or Bed ridded? Comatose? Can I die?

When the indications are clear cut, reasonable treatment goals are set preoperatively, skill set and technology is used efficiently/effectively and patient related factors are favorable, then, the chances of having such a catastrophic complications are extremely small. On the otherhand, not undergoing surgery or delaying it further, MAY end up, having, same complications that are being scrutinized and afraid of!

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# What is the cost?

Surgical cost of basic brain tumor surgery varies from hopsital to hospital and region to region. In Mumbai region, at a NABH accredited, corporate hospital, in a general ward the cost is approximately 2.0 Lakhs INR (and it increases depending on the facilities and bed status chosen and complexity of surgery. The cost may be lower for certain procedures such as VP shunts etc. Except of Stereotactic radiosurgery, (Gamma knife equivalent) there is no package deal and most of insurance companies are cover brain tumor surgeries.Do mail at hrishikesh.sarkar@hotmail.com for more. The charges are rough and as on March 2020

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# How many days in the hospital

From the day of surgery, for an uncomplicated case, you may need to stay for about 5-7 days. Every attempt is made to minimize the no of days in the hospital.

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# When can I resume work normally?

If further therapy such as radiation or chemo is not required then depending on the patient's physical and mental abililty judged by the Surgeon, patient can resume work normally after a month.

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# What are general dos and dont's following surgery?

Do's

- Maintain walking, sitting, interacting with relatives

- Maintain good fluid and salt intake

- Take medications as prescribed

- Visit for follow up visits as adviced

- Keep wound dry and clean

Dont's

- Skip medicines, particularly, if you are on those to prevent fits

- Drive, swim, contact sports or adventurous travel untill cleared by your Surgeon


# How do I take care of the wound?

- Keep the area clean

- Do not put any ointments, oil, lotions

- Do not scratch. If the scratching is intense contact

- Watch for fever, redness, pain, discharge or any visible area of thread jutting out

- The time for removal of staplers/ sutures will be informed to you

- Keep the area clean

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# What is the sequence of events once I decide to get operated?

1. Meet the secretary for estimate letter and proposed date of admission and surgery. For those who wish to avail Insurance - Get the documentation ready for insurance(TPA form) - Handled by TPA department

2. Visit Admission counter and book bed/ward/room/category

3. Visit Neuroanaesthetist(coordinated by Secretary) regarding evaluation of fitness for surgery and other relevant consultations

4. Once OK from fitness point and the finances/Insurance - Confirm date of Admission and Surgery

5. Once Admitted - Relevant technical scan and relevant consultations if required

6. Signing of informed consent and obtaining Clearance form from the finance department

7. Anaesthesia review in the ward, Time to OR notification, Nil by mouth notification

8. OR shift the next day, Anaesthesia Induction process begins

9. Surgery starts. Relatives in waiting area. Duration of procedure intimated and timely notification provided. Surgery ends

10. Shifted to ICU for observation for 12-24 hours

11. Relatives(only one or two) can now see the patient at this stage

12. Patient is shifted of out ICU back to the ward. Standard ward visitors rule apply.

13. Observed in ward for 3-4 days minimum and then discharged if all parameters appears fine

14. Discharge summary and advice regarding follow up

15. Billing clearance

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