All types of surgery carry some element of risk, but with brain surgery there are additional potential complications. The risk of infection is greater, and the potential for a severe or even life-threatening infection is also present. Other potential risks include brain swelling and fluid retention.
General Surgical Risks
All surgical procedures have a certain amount of risk associated with them. Many risks are common to multiple types of surgery. For example, most surgeries have a risk of post-operative wound infection, or bleeding at the wound site.
Some types of surgery have a risk of thrombosis, or a blood clot in a vein. This risk is due to the fact that after surgery many patients must spend a significant amount of time sedentary while they are recovering.
Another general surgical risk is that of hemorrhage during the surgery itself. This can occur if the surgery is performed in a highly vascularized location, such as in the liver.
Neurosurgery is a type of surgery in which all of these risks can be present. Because the brain is involved, however, the risks can be much greater, and the damage itself can be much greater if one of these risk situations does occur.
Brain Surgery Post-Operative Infection
The risk of brain surgery post-operative infection is significantly increased if the patient has undergone previous brain surgery, if the patient had a pre-existing infection, if the surgery was conducted as an emergency treatment, if the surgery was of more than four hours’ duration, if the patient is on a ventilator before or after surgery, if a cerebral spinal fluid leak occurs, and if the patient is catheterized.
People who are at risk of post-operative infection due to one or more risk factors are generally given prophylactic antibiotics to reduce the chance than an infection will develop. Prophylactic antibiotics can significantly reduce the risk of meningitis and deep wound infections such as abscesses.
A thromboembolism is a blood clot that develops in a vein or blood vessel and then breaks free from its original location. When this occurs, the clot travels through the vein or vessel and can eventually partially or fully block another vein or vessel. If a blood clot develops in the brain and becomes a thromboembolism, a potentially serious event such as a stroke might occur. The risks of this occurring can be reduced with blood thinning medications; however the use of such medications increases the risk of uncontrolled bleeding, therefore the risks must be carefully balanced.
Swelling and Fluid Retention
The brain is a delicate organ, and the skull is a hard and unyielding bone formation. Because of this, serious problems can occur if the brain swells excessively after surgery, or if post-surgery complications cause the retention of a large amount of fluid in the skull.
Brain swelling and fluid retention are potentially serious problems because they can cause an intense amount of pressure in the cranium, and the skull is too rigid to allow room for expansion. This means that expansion can only occur in the opposite direction, that is, into the brain. When this sort of pressure is put on the brain, events such as seizures can occur.
R. Patir, A. K. Mahapatra, A. K. Banerji. Risk factors in postoperative neurosurgical infection. Acta Neurochirurgica. Volume 119, Numbers 1-4 / March, 1992.
S. Boström, E. Holmgren, O. Jonsson, S. Lindberg, B. Lindström, I. Winsö and B. Zachrisson. Post-operative thromboembolism in neurosurgery Volume 80, Numbers 3-4 / September, 1986.