Your Cranial Surgery

Dr. Pagnanelli should have explained what procedure is being performed and why it is being performed. You should have had ample time to ask questions and have these questions clearly answered. Your options and alternatives should have been explained, as well as the risks and possible complications. If these things have not been done, then do not sign this paper. Instead, ask more questions until these goals have been accomplished.

The Day of Surgery

You will be taken to the Operating Room holding area on a stretcher. Here, you will be checked in by the nursing staff. Your identification, what is being done, and by whom will be verified. The anesthetist will place an intravenous (IV) in your arm. This is a small plastic tubing through which the medications will be given to put you to sleep. Later additional access lines will be placed, as are required for your surgery.

Your family, friends, etc will be directed to the O.R. waiting area, where I will look for them after surgery. Cranial surgery can take several hours. They will also receive periodic updates, as needed. They can always ask the waiting room staff for an update.

When the O.R. suite is ready you will be wheeled back to surgical suite. It will be a busy place. There will be several nurses, assistants, orderlies, and your surgeon busily preparing for your surgery. We will try to keep you as comfortable as possible. The anesthetist will give you a little sedation to relax you.

Once you been put to sleep and a breathing tube placed into you throat;

• A catheter (tube) will be placed in your bladder, and any additional monitoring equipment situated.
• You will be positioned appropriately for the surgery
• A head fixating device will be applied to hold your head still during surgery.
• As much hair as needed will be shaved to expose the planned surgical site, and decrease the chance of infection.
• Many of your body functions and parameters will be monitored throughout the procedure. Blood samples will be taken, and adjustments made appropriately.
• The surgical area will scrubbed and cleaned with antiseptic solution

Once all is in order, your surgeon will begin working. An incision is made and a window of bone is temporarily removed to gain access to the problem. If we are dealing with a tumor, as much tumor will be removed as is safe. It is often not possible to remove every cell without causing more problems. Throughout your surgery many different tools will be used, such as the microscope, laser, ultrasonic aspirator, micro-instrumentation, etc.

Once the work is completed, and the surgical site has been closely inspected, we will close.

Intensive Care (ICU)

A head bandage will be applied and you will be taken to the ICU. The breathing tube may or may not be removed at this time. The lines used to monitor your body will most likely remain in place, until we are satisfied that it is safe to remove them.

The ICU is a busy place and you will hear unfamiliar beeps and sounds. These are for your protection. Bright lights may be turned on for long periods of time, and your nurse will be adjusting your monitoring equipment and checking you constantly.

If you are in pain, let your nurse know. Don't be afraid to report any unexpected feelings to your nurse. The IV and other lines, as well as the breathing tube, will be removed when it is safe to do so. The nurse will be checking your vital signs regularly, monitoring your fluid intake and urine output, drawing blood studies, and adjusting equipment as needed. You will have post-operative CT scans and X-Rays regularly. While in the hospital, in addition to the nursing staff, you will be cared for by your primary care physician, a pulmonary specialist, and your surgeon. You may also be evaluated by physical therapy, speech therapy, occupational therapy, and by any other care provider that is needed.

Your stay in ICU could be one day or several days, depending upon your condition. You will then be transferred to the regular nursing floor. When you are ready, you will be discharged home. Some patients are more appropriately transferred to a skilled nursing facility or to a rehabilitation unit. This decision will not be made without you and your family.

In spite of the complicated nature of this surgery, outcomes are usually good. This outcome is dependent upon many factors. The attitude and general health of the patient, the experience of the surgeon and team, the location and exact nature of the problem with which we are dealing, the reasonable expectations set prior to surgery, etc. The exact tumor type will determine the long term outcome, and the need for additional treatment, such as radiation therapy, chemotherapy, and additional surgery.

Risks and Possible Complications

I have performed more than 2,000 cranial surgical procedures successfully. However, complications do occur:

1. Infection of the skin and/ or bone. This may require further surgery.
2. Bleeding which may require a blood transfusion and may result in brain damage. This may be permanent.
3. Leakage of spinal fluid through the wound. This may require further surgery.
4. Stroke or stroke - like complications which can cause weakness in the face, arms and/ or legs. This may be temporary or permanent.
5. Epilepsy which may require medication. This may be temporary or permanent.
6. Loss of vision which may be temporary or permanent.
7. The lesion may not be cured by surgery and may need further treatment.
8. Increased risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
9. Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.
10. Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
11. Clots in the legs (deep vein thrombosis or DVT) with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
12. A heart attack because of strain on the heart or a stroke.
13. Death is possible after any surgical procedure, including this one.

These possible complications pertain to anyone having cranial surgery. Dr. Pagnanelli, the O.R. team, and anesthetia personnel will do everything in their power to ensure that your procedure is carried out in a safe, professional, and responsible manner. The possibility of these risks is low, but still present.