Craniotomy for epileptic focus: my guide for patients

Introduction

A craniotomy for an epileptic focus is a procedure in which the abnormal brain tissue causing seizures is removed (resected) to try to prevent future seizures. This is a guide for my patients about what to expect from surgery. For background on the procedure itself, please see my craniotomy for epileptic focus page.

What to expect from surgery

• Most resections are performed with you asleep, under general anesthesia, and the operation takes 1-2 hours. If I plan to do part of your procedure awake, we will review what this entails and what to expect. You can also read about speech mapping.
• I close the incision with dissolvable sutures. A few staples may be used to attach the bandage, but they are removed the day after surgery.

Instructions before surgery

• If you take a blood thinner such as aspirin, Plavix, warfarin (Coumadin), Eliquis, Xarelto, Lovenox, or fish oil supplements, please hold it before surgery as we discussed in our office visit.
• The anesthesia service will provide you with instructions about eating and drinking before surgery.
• The pre-op department will usually give you a special soap to use before surgery.
• Please take your anti-seizure medications as normal on the morning of surgery.
• Plan to have whatever you need to stay in the hospital for 1-3 nights, and expect that a family member will need to drive you home when you leave.
• Please call my office with any questions.

In the hospital

• When surgery is finished, you will wake up in the operating room and then be transferred to the recovery area, and then to the neurologic intensive care unit. The ICU allows visitors, but not overnight visitors.
• Some patients with small lesions may spend the night in the neuro step-down unit, and this unit allows for overnight visitors. Please ask me which unit I expect to use for your case.
• Most patients have a bandage on the incision. Drains are rarely used. The bandage comes off the day after surgery.
• Most patients do not require another MRI after surgery.
• We use over-the-counter medications as well as opioids for pain control after surgery, but most patients do not need opioids for more than a few days to a week.
• Most patients stay in the hospital 1-2 nights.

After surgery

Wound care

• You can shower the day after surgery. Please wait 2-3 weeks before swimming or taking a bath.
• You will have a wound check in my office about 2 weeks after surgery.

Seizures and medications

• A seizure in the immediate postoperative period is not necessarily reason for concern, and it does not mean that the procedure will be ineffective in the long term.
• We will likely not reduce your anti-seizure medications for 6-12 months. Your neurologist will guide you through the process when it is time.
• You will be provided instructions about resuming your blood thinners.

Activity

• When you return home, sleeping with your head elevated for 1-2 nights can help reduce swelling.
• To the extent that it is possible, please avoid strenuous activity, heavy lifting, bending, and alcohol for 2-4 weeks.
• Walking is an excellent way to begin recovery from surgery. I would avoid exercise that causes you to sweat for at least 2 weeks.
• Incisional soreness is common for several weeks after surgery and gradually gets better.
• Most patients can fly after 1 week.
• Resuming driving entails a conversation between you, your family, and your epilepsy doctor, and it depends on how your recovery is proceeding and your seizure burden.
• Most patients can resume desk work within 1-2 weeks. You may need to wait closer to 4 weeks if your job is particularly physical.

Follow-up

You will see me for a wound check about 2 weeks after surgery, and you will continue to see your neurologist and epilepsy team as we follow your seizures over time.

When to call my office

Please be vigilant in the first few weeks after surgery. Notify my office if you develop any of the following:

• Fever higher than 101.5°F.
• Drainage from your incision or any other concerning incision issues. A little redness and tenderness is normal immediately after surgery, but it should get gradually better, not worse.
• New neurologic problems that are not associated with your usual seizures: weakness, numbness, difficulty speaking, visual changes, and so on.
• A seizure that is different from, or much worse than, your usual seizures.
• Severe or worsening headache.
• Confusion that gets gradually worse rather than better.

If you are experiencing a medical emergency, please call 911.

For questions or concerns that are not a medical emergency, you can reach my medical assistant directly at (720) 599-3075 or MDMian@carepointhc.com. You can also call the CarePoint Neurosurgery main line at (303) 515-2320.

If you or a family member is considering epilepsy surgery and has not yet met with me, please consider meeting me in consultation to learn more about your treatment options.