Our Summary

This research paper studied the safety and outcomes of performing a second awake brain surgery, known as a “redo” surgery. Awake brain surgery is a procedure where the patient is conscious during the operation, which is typically used to remove tumors near critical brain areas without damaging them. The study involved 607 surgeries performed by a single surgeon at Toronto Western Hospital from 2006-2018. Of these, 501 were first-time surgeries and 106 were redo surgeries.

The study found that redo surgeries took longer than first-time surgeries and had a slightly higher risk of needing another operation afterward, mainly because of post-surgery infections. However, the length of hospital stay, rates of bleeding after surgery, new neurological problems after surgery, and rates of patients being discharged home or readmitted to the hospital were not significantly different between first-time and redo surgeries.

In conclusion, although redo surgeries might take longer and have a slightly higher risk of needing another surgery due to infections, they were generally well tolerated. With extra care to prevent infections and promote wound healing, redo awake surgeries can be a good option for patients who need them.

FAQs

  1. What is a “redo” surgery in the context of awake brain surgery?
  2. Was there a significant difference in risk or outcomes between first-time surgeries and redo surgeries?
  3. How can the risks associated with redo surgeries, such as higher rates of infection, be mitigated?

Doctor’s Tip

Tip: If you are considering a redo craniotomy, make sure to discuss the risks and benefits with your surgeon. It’s important to follow post-operative care instructions closely to reduce the risk of infections and ensure proper healing. Regular follow-up appointments with your healthcare team are also important to monitor your recovery progress.

Suitable For

Patients who may be recommended for a craniotomy, including redo surgeries, include those with brain tumors, epilepsy, arteriovenous malformations, aneurysms, traumatic brain injuries, and other brain conditions that require surgical intervention. Additionally, patients who require biopsy or resection of brain lesions, treatment of brain abscesses, or relief of intracranial pressure may also be recommended for a craniotomy. Ultimately, the decision to undergo a craniotomy, whether it is a first-time surgery or a redo surgery, should be made in collaboration with a neurosurgeon based on the individual patient’s specific condition and needs.

Timeline

Before the craniotomy:

  1. Patient is diagnosed with a brain tumor or other condition that requires surgery.
  2. Consultation with neurosurgeon to discuss treatment options, including the possibility of a craniotomy.
  3. Pre-operative testing and preparation, including imaging scans, blood tests, and physical exams.

During the craniotomy:

  1. Patient is brought into the operating room and given anesthesia to put them to sleep.
  2. Surgeon makes an incision in the scalp and removes a portion of the skull to access the brain.
  3. In an awake craniotomy, the patient is woken up during the surgery to monitor brain function and ensure critical areas are not damaged.
  4. Surgeon removes the tumor or performs other necessary procedures.
  5. Skull is replaced and incision is closed.

After the craniotomy:

  1. Patient is monitored in the recovery room and then transferred to a hospital room for further observation.
  2. Patient may experience pain, swelling, and discomfort at the surgical site.
  3. Physical therapy and rehabilitation may be needed to regain strength and function.
  4. Follow-up appointments with the neurosurgeon to monitor recovery and discuss any ongoing symptoms or concerns.
  5. Long-term follow-up to monitor for recurrence of the tumor or other complications.

What to Ask Your Doctor

  1. What is the reason for recommending a craniotomy?
  2. What are the potential risks and complications associated with a craniotomy?
  3. How long is the recovery period after a craniotomy?
  4. What is the success rate of the craniotomy procedure for my specific condition?
  5. Will I need any additional treatments or therapies after the craniotomy?
  6. How many craniotomies have you performed, and what is your experience with this procedure?
  7. What is the expected outcome of the craniotomy in terms of improving my condition or symptoms?
  8. Are there any alternative treatment options to consider before proceeding with a craniotomy?
  9. How will my pain be managed during and after the craniotomy procedure?
  10. What follow-up care or monitoring will be needed after the craniotomy?

Reference

Authors: Takami H, Venkatraghavan L, Chowdhury T, Bernstein M. Journal: World Neurosurg. 2022 Nov;167:e922-e928. doi: 10.1016/j.wneu.2022.08.102. Epub 2022 Sep 14. PMID: 36113715