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Date issued: September 2023

Review date: September 2025

Ref: A-584/TM/Neurosurgery/Planned Surgery for Anterior front or middle meningioma

PDF:  Planned Surgery for Anterior front or middle meningioma final September 2023.pdf [pdf] 191KB

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. 

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.

Sometimes tumour is left behind to preserve the function of important structures in the skull base area.

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.

Preoperatively:

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 MUST STOP taking any blood thinning medications such as aspirin, nurofen, brufen etc., 7 to 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 several 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 may involve being cared for in a higher level of observation on the 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 recovery or similar high dependency area such as ICU / HDU with less patients per nurse.

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: small tube into an artery in your wrist, to measure blood pressure continuously.

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, arms, or feet -also to be able to administer drugs or fluids.

Monitoring: 3 or 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.

These will be removed when the clinical team decide that they are no longer required.

Multidisciplinary Team (MDT)

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

Before you leave, we may do a scan of your head as a baseline for future, we may ask the Endocrinologists to check your hormones are not affected by the surgery and we will probably ask you to do an eye test (Visual fields) on the ward.

How long will I be in hospital?

This will depend on the procedure you are undergoing, and admission can range from 3 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 gently 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 the ward as soon as possible 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 of the brain, 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 the ward or Clinical Nurse Specialist (if within working hours)

Fatigue/ Tiredness

Feeling particularly tired following surgery is quite usual. Fatigue is a problem for some patients long after other symptoms have disappeared. It is important to adjust your level of activity to your energy level. Please remember you have had major surgery to your head.

You may find it useful to take naps in the afternoon until your energy level returns. It is very important that you do not do too much when you get home. A slow gradual increase in your activity level wil help you to recover and will avoid the complications of immobility.

Listen to your body and rest when you feel you need to, only you know when your body requires to stop and recuperate!

Post operation

Following your surgery, it is very likely you will have a sore jaw and difficulty chewing. You may also experience a “dip” in the temple area of your skull. During the surgery the temporalis muscle is cut, it is a fan shaped muscle that attaches to the top of your skull and the point attaches to your jaw. After it is reattached, it should be “exercised” to maintain its elasticity and to regain full jaw movements. At the top where it joins the skull it sometimes “shrinks” a bit leading to a “dent” or “dip” in the skull that may or may not be obvious to look at.

Check your wound regularly (or ask a family member) to check it continues to heal after the staples / sutures are removed. If you notice any redness/ weeping or have any concerns, please contact your specialist nurse or GP practice for advice.

You may experience tingling and/ or itching as the wound begins to heal. It is common for the wound site to be numb for some time after surgery.

If you have an enquiry about:

• Clinic appointments: please contact Neurosurgery appointments via Derriford switchboard.

• An operation date: please contact your Consultant’s secretary.

• A scan appointment: please contact the Radiology Department via switchboard.

• Scan results: please contact your Consultant’s secretary if you have not heard within 6 weeks of your appointment.

Useful Telephone numbers

Switchboard Derriford: 01752 202082

Pre-assessment unit: 01752 431990

Postbridge:admissions ward:01752 431225

Pencarrow: post-operative high dependency ward: 

01752 431439

Erme: post-operative neurosurgical ward: 01752 792544

Tracy Mason : Skull Base Clinical Nurse Specialist

01752 433239

Mr Muquit’s Secretary:01752 437667