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Introduction

Not all Meningiomas require surgery, but you have been given the option of surgery.

This booklet aims to explain what may happen if you commence on the pathway towards surgery and what to expect afterwards.

There is a lot of information here; it is not intended that this will answer all your queries, so if you have any further questions, please do ask.    

Outpatient Appointment

At your appointment with the Consultant Neurosurgeon, the options open to you would have been discussed.

In brief, surgery is an option for a diagnosis of meningioma that is too large for Stereotactic Radiosurgery (SRS) treatment. There are risks and potential complications with a surgical approach.  Risks include permanent loss of hearing on the affected side and damage to the face movement nerve.  Tumour may be left behind in order to preserve function of the nerves in this area.  There can also be a risk to facial sensation, a risk of double vision, as well as a risk to swallowing and voice quality. 

Surgery

With surgery also comes the risk of rarer complications which can include:

• A small risk to your life

• A small risk of stroke   

• A small risk of infection due to wound complications or due to leakage of cerebral spinal fluid (CSF), the clear fluid that bathes and protects the brain.

Decisions about what is the best treatment option for you depend on many factors, such as tumour size, location, symptoms, your general health and the size of your tumour.

Your case will have been discussed within the multi-disciplinary skull base team, which consists of, at least:

3 Neurosurgeons, 2 ENT Consultants, 3 Consultant Oncologists, 1 radiologist, 1 Specialist Nurse/Advisor, 1 Histopathogist, 1 Co-ordinator.

Pre-operatively

If the outcome of your clinic consultation is for you to have an operation then you will need to attend for a pre-operative review/assessment.

The pre-assessment team is based near main outpatients on level 6, Derriford Hospital.

Unfortunately, if you live outside of the Derriford Hospital catchment area this assessment cannot be undertaken at your local hospital.

Pre-assessment is about checking your general health and fitness for surgery.

If you have not had pre-assessment at the time of your clinic review, your consultant’s secretary will arrange an appointment for you. You should receive a telephone call or a letter outlining the details of your appointment once booked. If you have any questions or concerns around the date or time of your appointment please contact the team using the telephone number on your appointment letter.

Your consultant may want you to have further investigations before surgery, for example a brain or spine Computerised Tomography (CT), Magnetic Resonance Imaging (MRI) or Magnetic Resonance Angiography (MRa) scan. These will be organised for you and undertaken at either your local hospital or co-ordinated with your pre-assessment appointment at Derriford Hospital.

You will need to avoid taking any blood thinning medications such as aspirin, nurofen, brufen etc., 7 – 10 days prior to your surgical procedure.  If you take regular blood thinning medications the pre assessment team, specialist nurse and/or consultant will advise you on how this will be managed in the pre and post-operative periods.

If you require analgesic medication for pain/discomfort please discuss with your General Practioner or speak with your specialist nurse/key worker.

Once you have attended pre-assessment and had any further investigations required you will then be ready for surgery.

Accommodation

Accommodation called “Hearts Together” is available for patients wishing to come the night before surgery and for relatives wishing to stay in Plymouth for a period of time. There are also a number of hotels available within close proximity to the hospital.  If relatives wish to stay locally it is their responsibility to arrange this.

Parking

If you need advice regarding parking or parking costs, please speak with the parking team based at the main reception desk who will be able to advise you or alternatively details are held on the main hospital website.

Surgery

A surgery date will be sent to you in the post or your consultant’s secretary will telephone you with a date along with any specific admission details. Your consultant might be able to give you an indication as to when your surgery will take place when you are seen in clinic, but please note this will only be a provisional date and you will need to await final confirmation by letter.

Patients undergoing neurosurgical procedures are admitted on the day of surgery to Postbridge Ward, Derriford Hospital, level 4 unless otherwise advised. Instructions will be sent to you in the post outlining your specific admission details.

Please note

Every effort is made to ensure your operation goes ahead as planned, however due to the nature of neurosurgery it is important that you are cared for in the ward area best suited to your post-operative needs. This often involves being cared for in the high dependency / intensive care area for a 12 - 24 hour period, prior to going back to the general neurosurgical ward.

If you require a higher level of care following surgery and the appropriate area is not available for you this may lead to a delay in your surgery. Every effort is made to avoid this but sometimes this situation is unavoidable.

Post–operatively

In the immediate post-operative period, you will be cared for in the intensive care unit for 12 – 48 hour period

During this period, you will be monitored closely by the medical and nursing team.

You will have various tubes and wires attached to you, the list below may or may not be present

Oxygen: either mask or prongs just inside your nostrils

Arterial Line: a small catheter in an artery in your wrist to allow for continuous monitoring of your blood pressure via a monitor and to be able to withdraw blood without causing you discomfort.

Central line: a catheter in a large vein in your neck with several ports on used by medical and nursing staff to administer fluids and drugs as required. Also used to withdraw blood without causing you discomfort.

Cannulas: in veins in your hands or arms -also to be able to administer drugs or fluids.

Monitoring: 5 leads attached to your chest to show heart rhythm, oxygen probe -a “peg” on your finger to show oxygen levels.

Naso: gastric (NG) Tube - to give you calories directly into your stomach bypassing your swallowing mechanism or to aspirate/ remove stomach contents if you are vomiting.

A catheter: to drain urine directly from your body, for monitoring fluid balance and to avoid discomfort of a full bladder.

Lumbar Drain: a tube into your lower back to drain cerebro spinal fluid (CSF) to give the brain space and allow the repairs to heal.

The majority of these will be removed when you leave ICU to transfer to the ward, but it is possible some like the NG tube, lumbar drain, catheter and cannulas will remain for a bit longer.

Multidisciplinary Team (MDT)

Along with the nursing team helping with your care you may also have involvement from the therapy team this may could include:

• Physiotherapist

• Occupational therapist

• Speech and language therapist

• Neuro psychologist

You will be referred to therapists by the managing ward team if required.

Generally, patients are starting to feel better after a couple of days and we would encourage patients to manage their own hygiene and mobility needs if able.

We would be looking at discharge to home once you are able to mobilise independently and that you have no further medical needs. 

How long will I be in hospital?

This will depend on the procedure you are undergoing, and admission can range from 5 days onwards.

Any complication may require a period of rehabilitation, this may necessitate a longer stay in hospital and may be undertaken at a hospital closer to your home address.

When should my clips/sutures be removed?

Once you are home you will need to arrange an appointment with your Practice Nurse or District Nurse this can be done via your General Practitioner (GP).

Ward staff please complete prior to discharge:

Date for removal: …………………………….

Clip removers: ……………………………..

Wound check and dressings:  ……………………………

When will I be allowed to wash my hair?

You are able to wash your hair the day after surgery.

What should I do if my wound becomes sore or inflamed once I go home? If your wound becomes, red, inflamed, painful, and/or you have a temperature please contact your GP within 24 hours for a review, antibiotics or a neurosurgical consultation might be required.

Headaches

Headaches are troublesome for some. The pain may be related to irritation of the lining of the brain (the dura), inflammation, muscle spasm, anxiety, or other unknown causes.

Headaches immediately after surgery are common but should be resolving or disappeared by discharge from hospital.

It is recommended that you do not use paracetamol for more than 11 days in the month, in the post operative period.

If headaches do persist and are not relieved by pain killers, the light hurts your eyes, you have a stiff neck, or they are accompanied by vomiting then please contact your GP or Clinical Nurse Specialist.

Fatigue/ Tiredness