Head operations are considered interventions of increased complexity and trauma. They are carried out only when there is a direct threat to the patient’s life, in the absence of the effect of conservative treatment or in case of disability. After surgery on the head, a full recovery period is necessary.
When are operations performed?
They become necessary:
- with hematomas, tumors or abscesses to remove affected tissue sites;
- to restore the structure of the skull with birth defects or injuries;
- to restore normal blood flow in case of vascular damage (thrombosis, obstruction);
- to restore nerve fibers.
Such violations often occur just with head injuries.
Another cause are GM tumors:
- malignant and benign (at the risk of malignancy or impaired function);
- purulent processes associated with infectious penetration;
- epileptic status.
Possible contraindications
Head surgery is very dangerous and often complicated. Contraindications are not taken into account only in emergency cases, when the lesser of 2 evils is chosen. A ban may be:
- elderly age;
- renal failure;
- pathology of the heart and blood vessels;
- diabetes;
- pulmonary insufficiency in the stage of decompensation;
- decreased blood clotting;
- purulent inflammation and oncology in other organs;
- coma and shock.
Types of operations
Operations on the head consist of several stages:
- preparation;
- creation of conditions for penetration into the affected area;
- carrying out surgical procedures;
- rehabilitation period.
There are several specific methods for such surgical interventions.
According to their focus, operations on the head are divided into: radical and palliative, as well as symptomatic to eliminate certain manifestations. They are akin to palliative when a complete cure is impossible and the cause is partially eliminated, for example, the creation of new ways of cerebrospinal fluid outflow from the ventricles of the brain in inoperable tumors.
Radical operations with complete cure are performed for hematomas, abscesses, deformities and injuries of the skull itself.
By the nature of the preparation of the intervention, they are divided into:
- emergency, or urgent, to save life;
- urgent;
- planned.
A full study is possible only with the latter type.
Emergency interventions are usually carried out with traumatic hematomas, with acute obstruction of the cerebrospinal fluid paths, with the development of compression of the stem sections of the brain in the large occipital foramen. Also, brain operations are open type (craniotomy) and stereotactic (from the Greek. Stereos - spatial and Greek. Taxis - location), when access to the brain is through a small milling hole. Then, various instruments are introduced into precisely defined deep parts of the brain: electrodes, cannulas, and biopsy devices.
All of them are introduced using special stereotactic devices attached to the patient’s head. They have devices that serve as a guide in space and determine the depth of immersion.
For precise coordination, stereotactic atlases and CT or MRI data are used. At the same time, accuracy of up to 1 mm is observed. This type of intervention is especially actively used in functional neurosurgery in the treatment of hyperkinesis, epilepsy, etc.
Recently, the absence of devices is also possible, when the surgeon has the ability to reproduce any sections of the brain using CT, MRI, and the instruments are located using infrared radiation.
Endoscopic surgery is another type of surgery for GM.
Endoscopy is, for example, an operation of a cyst in the head through punctures. With impaired vision, this type is not used.
Trepanation is the most frequent and effective method, but it is traumatic. More often it is carried out during manipulations on the ventricles of the brain.
Radiosurgical interventions are another method. Spatial orientation is also used here, but a gamma knife is used for strictly focused radiation exposure. This installation was developed by A. Lexell, a renowned neurosurgery specialist from Sweden.
A gamma knife, or Cyber-knife, is a huge helmet in which 201 point high-frequency source of gamma rays of radioactive Cobalt-60 are mounted, which are focused in the isocenter in the form of a mono beam.
In this case, neighboring tissues are not irradiated. These rays directly destroy the DNA of tumor cells. The irradiation stops the growth of the tumor and its blood supply. The procedure is required one and it lasts from one to several hours. The method is very accurate and the risk of complications is minimal. It is used only for diseases of GM.
Endovasal interventions - used for vascular pathologies. The essence of the method is that catheters are inserted into a large vessel under x-ray control. On them, special occlusive devices are delivered to the affected vessel. The impact is accurate. For catheterization, the femoral or carotid artery is used. Local anesthesia, because the tolerability of such interventions is easier than an open type of surgery with anesthesia.
Reviews about the various methods are contradictory. It all depends on the neglect of the disease and the professionalism of the medical staff.
Providing access to the brain
There are 2 technologies: milling holes and craniotomy. In the first case, several holes with a diameter of 18-26 mm are drilled using a cutter. A crown cutter is used more often than others; it cuts a round flap in the skull. After completion of the manipulations, the flap is put in place. When the flap is returned after surgery on the head, it is fixed with special bone sutures.
Trepanation is the opening of the cranium. Then it becomes possible to work with a scalpel. Trepanation is also carried out in 2 ways: resection and bone-plastic.
The resection method is the removal of the bone area after the hole formed by the cutter with bone nippers. This is done in case of bone damage or in emergency cases. Sometimes access to the brain is obtained through the paranasal sinuses (transnasal) and the oral cavity (transsphenoidal access).
Apply with median or deep tumors in the region of the Turkish saddle.
What after surgery?
Tubes of rubber, the ends of which are under the bandage, are brought under the flaps. The blood mass impregnating the bandage flows through them. Even if the dressing is wet, it is not removed, and an additional layer is wound on top.
If CSF appears in the blood mass, this indicates a violation of the tightness of the suturing of the meninges and is a complication, which is called secondary cerebrospinal fluid. This should be strictly monitored by staff. With a significant swelling of bandages, urgent measures are taken.
After a day, the exhaust pipes are removed. In their place to prevent infection impose and knit provisional, or additional seams.
Complications
Trepanation is very rare without complications.
The severity in this case depends on the cause of the operation, the patient's age and general condition. Among the complications:
- bleeding
- infection
- swelling;
- disorders of the brain tissue that can cause impaired memory, speech and vision;
- seizure
- paralysis;
- digestive tract disorders.
Pain after surgery on the head appears very often and immediately due to an increase in ICP, even with the right intervention.
Infectious complications
More often than not they touch the brain itself, but the lungs, intestines, and bladder. This is due to forced restrictions on human mobility after surgery.
Treatment of infections involves antibiotic therapy.
Blood clots and blood clots
The operation or the pathology of the brain itself can cause the appearance of blood clots.
More often, blood clots occur in the veins of the legs. During their migration, the development of pulmonary embolism (pulmonary embolism) is possible , which often leads to death. Antiplatelet agents are prescribed to thin the blood.
Neurological disorders - more often they are temporary and are caused by edema of neighboring brain tissues. First of all, they are expressed in the fact that after the operation, the head hurts. To relieve swelling of the tissues, steroids are prescribed - Decadron and Prednisone. Convulsions may also occur, for the removal of which anticonvulsants are prescribed before the operation.
Bleeding
They occur in the trepanation zone due to vascular damage. Active leakage of blood, in the first day after the operation, is eliminated with the help of excretory tubes. If bleeding continues, the operation is repeated.
The most common effects of trepanation
Negative consequences can be expressed in impaired hearing or vision, deformation of the excised area of ​​the skull. As a rule, after the operation, the headache hurts, and this syndrome is poorly relieved by analgesics. For the treatment of all consequences, a long conservative treatment is carried out.
Brain tumor
Neoplasms occur when the process of uncontrolled division of immature tumors (primary) or tumors from other organs (secondary) starts.
The incidence of GM tumors is less common than in other organs. They are single and multiple, malignant and benign.
Non-cancerous tumors are characterized by slow growth, do not metastasize and do not grow into nearby tissues. Surgery may only be required when squeezing adjacent tissue with a neoplasm.
Malignant ones behave aggressively: they grow quickly, affect surrounding tissues and metastasize. In the clinic of tumors, cerebral and focal symptoms are distinguished.
Cerebral symptoms
More often it becomes a consequence of increased ICP. Of the manifestations, we can distinguish:
- dizziness;
- intense headaches that do not respond to analgesics;
- vomiting and nausea without relief.
Focal symptoms are diverse. These include:
- motor disorders in the form of paralysis and paresis;
- with cerebellar lesions - impaired coordination and gait;
- changes in spatial position of the body;
- violation of sensitivity - pain and tactile;
- violation of oral and written speech, if the tumor is localized in the speech zone, changes gradually increase in the form of inarticulate sound reproduction and handwriting in the form of doodles;
- hearing and vision impairment: the patient cannot recognize text and objects - visual acuity decreases;
- convulsive syndrome, occurs due to irritation of the cortex by a growing tumor, more often observed in young people;
- vegetative disturbances: instability of pulse and pressure, weakness, fatigue;
- psycho-emotional instability, loss of memory and attention;
- hormonal dysfunction - with processes in the pituitary gland and hypothalamus.
Diagnostics
Apply X-ray of the skull, CT, MRI with contrast. If any neoplasms are detected, a histological examination is performed. This is necessary to recognize the type of tumor, on which the further treatment algorithm depends. It is also mandatory to conduct an EEG, examination of the fundus.
Treatment
Therapy includes 3 approaches:
- operation;
- chemotherapy;
- radiation therapy and radiosurgery.
According to statistics, these 3 stages at an early stage of the disease give chances of 5-year survival in 60-80% of patients. With the treatment started late and tumor inoperability, the survival rate is already only 30-40% of patients.
Operation
Head surgery for a brain tumor is performed with limited education from neighboring tissues. Removal may be complete or partial. Duration and outcome depend on:
- initial state;
- age of the patient;
- doctor's experience;
- associated pathologies.
During the operation, the table is raised by 20-30 degrees. Adequate analgesia is important because headache after surgery is always present. Most often used "Morphine" - a convenient and safe analgesic, taken even orally.
After surgery, dizzy, nausea and vomiting occur. These conditions must be stopped.
Different tumors cause various complications:
- Removal of meningiomas - such tumors compress the frontal lobes for a long time and cause edema. Therefore, after surgery, sedation and ventilation continue necessarily.
- Resection of the temporal lobes leads to subsidence conditions for several days.
- Gliomas cause edema, which can result in edema of the entire brain with mortality.
- With tumors of the posterior cranial fossa, bulbar symptoms develop, protective reflexes of the upper respiratory tract (cough, for example) do not work, which makes the patient completely defenseless against infections.
Contraindications for operations with malignant tumors
The following factors can be attributed to the main contraindications:
- severe decompensation from organs and systems;
- many metastases;
- cachexia.
Postoperative period
In addition to medicines, mandatory are: physiotherapy and testing the functions (neural connections) of GM. The patient must consult with a neurologist and psychologist. After 2-3 weeks, the patient is sent for secondary rehabilitation on an outpatient basis.
The process of postoperative rehabilitation is complicated by the fact that there are many successive stages that are equally important and individual.
The main thing here is the complete elimination of noise and stress. Monitoring the healing and disinfection of wounds.
No overload in the first 10 days, up to removal of sutures.
Of the drugs, the selection of analgesics is important, because the pain causes additional stress and the patient again falls into the risk zone. Antiemetic drugs are also required.
The full recovery package includes:
- physiotherapy;
- restoration of lost or damaged skills;
- adaptation to the consequences of the operation;
- learning new skills, occupational therapy;
- Exercise therapy and massages;
- walks in the hospital;
- psychotherapy.
In the recovery period, a multidisciplinary team is involved, which includes a surgeon, chemotherapist, radiologist, psychologist, physician and physical therapy instructor, physiotherapist, middle and junior staff. Only in this case, the rehabilitation will be of high quality and comprehensive.
Among the methods of physiotherapy can be called myostimulation, magneto-and phototherapy. The complexes of exercise therapy include exercises with balls, weights. They should be performed before fatigue, but not to pain. The rehabilitation process as a whole lasts up to 3-4 months.
Each patient has their own rehabilitation program. It contains short and long term goals.
Short-term goals are achieved in a short period. For example, learn how to sit in bed yourself.
Further, verticalization of the patient, restoration of walking and other lost functions, etc. are necessary. The tasks are gradually expanding. This allows you to observe the dynamics of the process. Rehabilitation may not lead to a full recovery, but it will teach you how to improve your condition for a quality life in the future.
Contraindications after surgery
After the operation is prohibited:
- Alcohol for a long time.
- Air travel after surgery on the head is possible only after 3 months.
- Dangerous for the head sports: boxing, football, etc. - are excluded for a year.
- One day after the removal of sutures with craniotomy, you can wash your hair after surgery.
- Running is better than walking.
- Excluded insolation due to carcinogenicity.
- Therapeutic mud and vitamins gr. It is also better not to take.
Chemotherapy
It is aimed at the destruction of pathological cells. It is combined with surgery.
Methods of administration of cytostatics:
- directly into the tumor or into adjacent tissues;
- in / muscular;
- intravenously;
- in / arterial;
- into the cavity after removal of the tumor;
- in CSF - intrathecal.
Radiation therapy is based on the fact that abnormal cells are more sensitive to radiation. This treatment is also used for benign tumors instead of surgery if there is no access to the brain. Or it is carried out after the operation to remove the remains of the tumor during its germination in neighboring tissues.
Side effects may include:
- skin burns;
- soft tissue hemorrhage;
- skin ulcers;
- alopecia;
- the effect on the body of the decay products of the tumor;
- may be dizzy after surgery;
- pigmentation at the venue.
Head transplant operation
On November 17, 2017, news of a head transplant operation in China appeared.
Such surgery was the first in the world and lasted 18 hours. But the manipulation consisted only of a head transplant from one corpse to another, without a living donor.
The beginning of the story
In early 2015, the Italian doctor Sergio Canavero announced that he was ready to perform an operation to remove the head and transplant it from a living volunteer to a donor body.
32-year-old Russian programmer Valery Spiridonov offered himself as a patient, because he has a congenital pathology - Verdnig-Hoffman syndrome (1 in 100 thousand patients occurs).
With this progressive disease, all back muscles are completely atrophied. An agreement was reached in a personal meeting with the surgeon.
The donor was planned to be found among victims of car accidents or among those sentenced to death. But the Chinese government, sponsoring the operation, insisted that the patient must be Chinese so that the donor is the same race as the patient.
Spiridonov’s head on the Chinese’s body doesn’t take root. Everything froze and it is difficult to predict how the operation will take place on a head transplant at Spiridonov in the future. The success of the operation depends on the connection of the spinal cord with nerves and blood vessels.
Previously, Sergio did experiments only on mice, transplanting his head from one mouse to another. But the operation to remove the head and transplant its monkey was unsuccessful. The animal experienced severe torment, and doctors had to euthanize it after 20 hours. This is the latest news about a head transplant operation from Russian scientists who are also planning to conduct such an experiment, which is already planned for 2025.
In 2002, several head transplants were also performed on rats in Japan . Then it was revealed that for a successful outcome, it is necessary to ensure low temperatures.
In the case of a person, it will be necessary to cool the brain to a state where all neural activity is stopped. Only then will the neurons die. According to the Americans, even if the operation is successful, it is impossible to predict how the brain will work with new organs and what changes will occur in it. In addition, there are no effective methods of suppressing the reaction of rejection of a foreign head and suppuration processes.