Brain surgery is performed to treat problems in the brain or structures around it. An incision is made in the scalp and a bone flap is removed from the skull to access the brain. The surgeon performs procedures through this opening to treat conditions like tumors, aneurysms, or infections. Afterward, the bone flap is usually replaced and the scalp incision closed. Risks include reactions to anesthesia, bleeding or infection in the brain, and neurological problems that may be temporary or permanent.

1. Coplats dee 2010/ stroke assessment<br />Brain surgery<br />Brain surgery treats problems in the brain and the structures around it through an opening (craniotomy) in the skull (cranium).<br />Description<br />The hair on part of the scalp is shaved. The scalp is cleansed and prepared for surgery. An incision is made through the scalp. The incision may be made behind the hairline and in front of your ear, at the hairline near your neck, or elsewhere, based on where the problem in your brain is located.<br />The scalp is pulled up. A hole is created in the skull. A piece of the skull (a bone flap) is removed. Most of the time, this flap will be placed back after the surgery is over.<br />Through this hole, your surgeon may clip off an aneurysm to cut off the blood flow, biopsy or remove a tumor, remove an abnormal part of your brain, or drain blood or an infection.<br />Your surgeon may use a special microscope to perform the procedure. Monitors to check pressure may also be used.<br />If possible, the surgeon will make a smaller hole and insert a tube with a light and camera on the end (endoscope). The surgery will be done with tools placed through the endoscope.<br />The surgeon may use computers to help find the exact spot that needs to be treated (MRI or CT scans).<br />The bone is usually replaced and secured in place using small metal plates, sutures, or wires. The bone flap may not be put back if your surgery involved a tumor or an infection, or if the brain was swollen. (This is called a craniectomy.)<br />The time it takes for the surgery varies based on the type of problem that is being treated.<br />Why the Procedure is Performed<br />Brain surgery may be needed to treat or remove:<br />Brain tumors<br />Bleeding (hemorrhage) or blood clots (hematomas) from injuries (subdural hematoma or epidural hematomas)<br />Weaknesses in blood vessels (cerebral aneurysms) See also: Brain aneurysm repair<br />Abnormal blood vessels (arteriovenous malformations; AVM)<br />Damage to tissues covering the brain (dura)<br />Infections in the brain (brain abscesses)<br />Severe nerve or facial pain (such as trigeminal neuralgia or tic douloureux)<br />Skull fractures<br />Pressure in the brain after an injury or stroke<br />Some forms of seizure disorders (epilepsy)<br />Certain brain diseases (such as Parkinson’s disease) that may be helped with an implanted electronic device<br />Risks<br />Risks for any anesthesia are:<br />Reactions to medications<br />Problems breathing<br />Possible risks of brain surgery are:<br />Surgery on any one area may cause problems with speech, memory, muscle weakness, balance, vision, coordination, and other functions. These problems may last a short while or they may not go away.<br />Blood clot or bleeding in the brain<br />Seizures<br />Stroke<br />Coma<br />Infection in the brain, in the wound, or in the skull<br />Brain swelling<br />Before the Procedure<br />You will have a thorough physical exam. Your doctor may perform many laboratory and x-ray tests.<br />Always tell your doctor or nurse:<br />If you could be pregnant<br />What drugs you are taking, even drugs, supplements, vitamins, or herbs you bought without a prescription<br />If you have been drinking a lot of alcohol<br />During the days before the surgery:<br />You may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.<br />Ask your doctor which drugs you should still take on the day of the surgery.<br />Always try to stop smoking. Ask your doctor for help.<br />Your doctor or nurse may ask you to wash your hair with a special shampoo the night before surgery.<br />On the day of the surgery:<br />You will usually be asked not to drink or eat anything for 8 to 12 hours before the surgery.<br />Take the drugs your doctor told you to take with a small sip of water.<br />Your doctor or nurse will tell you when to arrive at the hospital.<br />After the Procedure<br />After surgery, you'll be closely watched in the intensive care unit (ICU). When you are stable, you will then go to a room where a doctor or nurse will monitor you closely to make sure your brain functions are working well. They may ask you questions, shine a light in your eyes, and ask you to do simple tasks. You may need oxygen for a few days.<br />The head of your bed will be kept higher to help reduce swelling of your face or head, which is normal.<br />You may have pain after surgery while you are in the hospital. Your doctor or nurse will give you medicines to help with this.<br />You will usually stay in the hospital for 3 to 7 days. You may need physical therapy (rehabilitation) while you are in the hospital or after you leave the hospital.<br />Outlook (Prognosis)<br />The results depend on the disease or problem being treated, your general health, which part of the brain is involved, what procedure is being done, and the surgical techniques used.<br />Alternative Names<br />Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy<br />EEG<br />An electroencephalogram (EEG) is a test to detect problems in the electrical activity of the brain.<br />How the Test is Performed<br />Brain cells communicate with each other by producing tiny electrical impulses. In an EEG, this faint electrical activity is measured by putting electrodes on the scalp.<br />The test is performed by an EEG technician in your health care provider's office, at a hospital, or at an independent laboratory. You will be asked to lie on your back on a bed or in a reclining chair.<br />The technician will apply between 16 and 25 flat metal disks (electrodes) in different positions on your scalp. The disks are held in place with a sticky paste. The electrodes are connected by wires to an amplifier and a recording machine.<br />The recording machine converts the electrical impulses into patterns that can be seen on a computer screen, as well as stored on a computer disk. Before computers, the activity was printed on paper. In either case, the electical activity looks like a series of wavy lines. You will need to lie still with your eyes closed because any movement can alter the results.<br />You may be asked to do certain things during the recording, such as breathe deeply and rapidly for several minutes or look at a bright flashing light.<br />How to Prepare for the Test<br />You will need to wash your hair the night before the test. Do not use any oils, sprays, or conditioner on your hair before this test.<br />Your health care provider may want you to stop taking certain medications before the test. Do not change or stop medications without first talking to your health care provider.<br />You should avoid all foods containing caffeine for 8 hours before the test.<br />Sometimes it is necessary to sleep during the test, so you may be asked to reduce your sleep time the night before. If you're asked to sleep as little as possible before the test, don't consume any caffeine, energy drinks, or other products that help you stay awake.<br />How the Test Will Feel<br />This test causes no discomfort. Although having electrodes pasted onto your skin may feel strange, they only record activity and do not produce any sensation. No significant electricity passes from the electrode into your skin.<br />Why the Test is Performed<br />EEG is used to help diagnose if you're having seizures and if so, what type. An EEG is also used to find the causes of confusion, and to evaluate head injuries, tumors, infections, degenerative diseases such as Alzheimer's disease, and abnormal changes in body chemistry that affect the brain.<br />It is also used to:<br />Evaluate problems with sleep ( sleep disorders)<br />To investigate periods of unconsciousness<br />To monitor the brain during brain surgery<br />The EEG may be done to show that the brain has no activity, in the case of someone in a deep coma. It can be helpful when trying to decide if someone is brain dead.<br />EEG cannot be used to measure intelligence.<br />Normal Results<br />Brain electrical activity has certain frequencies (the number of waves per second) that are normal for different levels of consciousness. For example, brain waves are faster when you are awake, and slower when you're sleeping. There are also normal patterns to these waves. These frequencies and patterns are what the EEG reader looks for.<br />What Abnormal Results Mean<br />Abnormal results on an EEG test may be due to:<br />An abnormal structure in the brain (such as a brain tumor)<br />Attention problems<br />Tissue death due to a blockage in blood flow (cerebral infarction)<br />Drug or alcohol abuse<br />Head injury<br />Inflammation of the brain (encephalitis)<br />Hemorrhage (abnormal bleeding caused by a ruptured blood vessel)<br />Migraines (in some cases)<br />Seizure disorder (such as epilepsy or convulsions)<br />Sleep disorder (such as narcolepsy)<br />Note: A normal EEG does not mean that a seizure did not occur.<br />Risks<br />The procedure is very safe. However, the flashing lights or fast breathing (hyperventilation) required during the test may trigger seizures in those with seizure disorders. The health care provider performing the EEG is trained to take care of you if this happens.<br />It may be difficult to get the paste out of your hair, but it should come out after a few washings with regular shampoo.<br />Alternative Names<br />Electroencephalogram; Brain wave test<br />Lipoprotein-a<br />Lipoproteins are molecules made of proteins and fat. They carry cholesterol and similar substances through the blood.<br />A blood test can be done to measure a specific type of lipoprotein called lipoprotein-a, or Lp(a). Lp(a) is considered a risk factor for heart disease.<br />How the Test is Performed<br />Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.<br />Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.<br />Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.<br />How to Prepare for the Test<br />You will be asked not to eat anything for 12 hours before the test.<br />Do not smoke before the test.<br />How the Test Will Feel<br />A needle is inserted to draw blood. You may feel moderate pain, or only a prick or stinging sensation. Afterward, there may be some throbbing.<br />Why the Test is Performed<br />High levels of lipoproteins can increase the risk of heart disease. The test is done to check your risk ofatherosclerosis, stroke, and heart attack.<br />Normal Results<br />Normal values are below 30 mg/dL (milligrams per deciliter).<br />Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.<br />What Abnormal Results Mean<br />Higher than normal values of Lp(a) are associated with a high risk for atherosclerosis, stroke, and heart attack.<br />Risks<br />Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.<br />Other risks associated with having blood drawn are slight but may include:<br />Excessive bleeding<br />Fainting or feeling light-headed<br />Hematoma (blood accumulating under the skin)<br />Infection (a slight risk any time the skin is broken)<br />Alternative Names<br />Lp(a) Magnetic resonance angiography<br />Magnetic resonance angiography is an MRI exam of the blood vessels. Unlike traditional angiography that involves placing a tube (catheter) into the body, MRA is considered noninvasive.<br />How the Test is Performed<br />You will lie down on a narrow table, which slides into a large tunnel-like tube inside the MRI scanner. You must lie very still during the exam because movement can make the images blurry.<br />The MRI uses very powerful magnets and radio waves to create clear, detailed pictures of the body. Because of the strong magnets, metal objects must stay outside the room.<br />A complete scan may take 1 hour or more. In some cases, a dye (contrast medium) is needed to make blood vessels show up better during the MRI. The contrast medium will be given through a needle (IV) placed in your arm.<br />How to Prepare for the Test<br />Most places require you to wear a medical gown. You must remove all jewelry and all other metal objects, including watches, and leave them outside the exam room.<br />Make sure you tell the radiologist if you have any of the following:<br />Metal screws, pins, plates, or staples in your body<br />Heart pacemaker<br />Intrauterine device (IUD)<br />Any type of metal implant in the ear or eye<br />Bullet fragments in the body<br />Implanted neurostimulator<br />Insulin or chemotherapy port<br />If you are pregnant, be sure to tell your doctor and radiologist before having this test.<br />Also tell the radiologist if you have kidney disease or are on dialysis, as this may affect whether you can have IV contrast.<br />How the Test Will Feel<br />The exam is not painful. Some people may feel some pain when the IV is placed into the arm. In addition, some people may have anxiety because the scanner is very close to the body. If you are claustrophobic, tell your health care provider. You may be given a mild sedative.<br />The table may be hard or cold. You may wish to ask for a blanket or pillow.<br />The machine produces loud thumping and humming noises. Ear plugs are usually given to reduce the noise.<br />Why the Test is Performed<br />MRA is used to look at the blood vessels in all parts of the body, including the head, heart, abdomen, lungs, kidneys, and legs.<br />It may be used to diagnose or evaluate conditions such as:<br />Arterial aneurysm<br />Aortic coarctation<br />Aortic dissection<br />Stroke<br />Carotid artery disease<br />Atherosclerosis of the arms or legs<br />Heart disease, including congenital heart disease<br />Mesenteric artery ischemia<br />Renal artery stenosis (narrowing of the blood vessels in the kidneys)<br />Normal Results<br />A normal result means the blood vessels do not show any signs of narrowing or blockage.<br />What Abnormal Results Mean<br />An abnormal exam suggests a problem with one or more blood vessels. This may suggest atherosclerosis, trauma, a congenital disease, or other vascular condition.<br />Risks<br />MR angiography is generally safe. However, people have been harmed in MRI machines when metal was in their body or a metal object was in the room. It is very important to tell your health care provider of any metal implants and to always remove all metal from your body and clothing before the test.<br />There have been reports of patients with kidney failure developing rheumatological disease after receiving MRI contrast agents.<br />Alternative Names<br />MRA; Angiography - magnetic resonance<br />