Our Summary

This research paper is about how surgery, and the body’s inflammatory response to it, can negatively affect the brain. The brain is responsible for managing the body’s immune response, but it can also be affected by that response. If inflammation from surgery isn’t controlled properly, it can cause long-term inflammation in the brain. This can disrupt the brain’s ability to learn and remember, leading to problems like postoperative delirium, which is confusion after surgery, and postoperative cognitive dysfunction, which is a longer-term decline in mental function.

It’s not fully understood how these problems are related, but both can lead to earlier onset of dementia and a higher chance of dying. The body’s immune response to surgery is meant to protect the body and help it recover, but it can also cause cognitive problems. This is especially true in older people and people with lifestyle-related diseases like obesity and insulin resistance, where inflammation can be more severe and long-lasting.

The paper also discusses how to identify patients who are at high risk for these problems and suggests potential treatments, both drug-based and otherwise.

FAQs

  1. How can the body’s inflammatory response to surgery negatively affect the brain?
  2. What problems can long-term inflammation in the brain lead to after surgery?
  3. How can we identify patients who are at high risk for postoperative cognitive dysfunction and delirium?

Doctor’s Tip

One helpful tip a doctor might tell a patient about brain surgery is to follow all post-operative care instructions carefully to minimize the risk of complications. This may include taking prescribed medications, attending follow-up appointments, and following any restrictions on physical activity. It’s important to communicate any concerning symptoms or changes in cognitive function to your healthcare provider immediately. Additionally, maintaining a healthy lifestyle with regular exercise, a balanced diet, and adequate sleep can help support brain health during the recovery process.

Suitable For

Patients who are typically recommended for brain surgery include those with:

  1. Brain tumors: Patients with tumors in the brain may require surgery to remove the tumor and prevent further damage to surrounding brain tissue.

  2. Epilepsy: Patients with severe epilepsy that does not respond to medication may be recommended for surgery to remove the area of the brain causing the seizures.

  3. Traumatic brain injury: Patients with severe traumatic brain injuries may require surgery to repair damage to the brain and reduce swelling.

  4. Cerebrovascular disorders: Patients with conditions such as aneurysms, arteriovenous malformations, or strokes may require surgery to repair or remove the affected blood vessels in the brain.

  5. Hydrocephalus: Patients with hydrocephalus, a condition characterized by an excess of cerebrospinal fluid in the brain, may require surgery to implant a shunt to drain the fluid and relieve pressure on the brain.

  6. Movement disorders: Patients with movement disorders such as Parkinson’s disease or essential tremor may be recommended for surgery to implant deep brain stimulation electrodes to help control symptoms.

  7. Chiari malformation: Patients with Chiari malformation, a condition where the lower part of the cerebellum extends into the spinal canal, may require surgery to decompress the brainstem and spinal cord.

Overall, patients who are recommended for brain surgery are those who have conditions that cannot be effectively treated with medication or other non-surgical interventions, and for whom surgery offers the best chance of improving their symptoms and quality of life.

Timeline

Before brain surgery:

  • Patient meets with neurosurgeon to discuss the procedure, risks, and benefits
  • Patient undergoes pre-operative testing, such as blood work, imaging scans, and neurological exams
  • Patient may need to stop taking certain medications or alter their diet in preparation for surgery
  • Patient is admitted to the hospital on the day of surgery and undergoes anesthesia before the procedure

After brain surgery:

  • Patient wakes up in the recovery room and may experience pain, nausea, or confusion
  • Patient is closely monitored for any complications, such as bleeding or infection
  • Patient may need to stay in the hospital for a few days to recover before being discharged
  • Patient will have follow-up appointments with the neurosurgeon to monitor their progress and discuss any ongoing symptoms or concerns
  • Patient may need physical therapy or rehabilitation to regain strength and function after surgery

Overall, the timeline of a patient’s experience before and after brain surgery can vary depending on the type of surgery and the individual’s unique health needs. It is important for patients to closely follow their healthcare provider’s instructions and attend all follow-up appointments to ensure a successful recovery.

What to Ask Your Doctor

  1. What specific type of brain surgery will I be undergoing?
  2. What are the potential risks and complications associated with this surgery?
  3. How will the surgery affect my brain’s inflammatory response?
  4. What steps will be taken to control inflammation during and after the surgery?
  5. What are the potential long-term effects of inflammation on my brain?
  6. How will my cognitive function be monitored post-surgery?
  7. What can I do to reduce my risk of postoperative delirium and cognitive dysfunction?
  8. Are there any specific medications or treatments that can help prevent or alleviate these cognitive issues?
  9. How will my overall health and any pre-existing conditions impact my recovery from brain surgery?
  10. What is the expected timeline for recovery and when can I expect to see improvements in my cognitive function?

Reference

Authors: Saxena S, Maze M. Journal: Presse Med. 2018 Apr;47(4 Pt 2):e73-e81. doi: 10.1016/j.lpm.2018.03.011. Epub 2018 Apr 12. PMID: 29656802