The procedures
Neurosurgery covers operations on the brain, its blood vessels and its coverings. Common procedures include:
- Craniotomy: the surgeon temporarily removes a small section of the skull to reach the brain, for example to remove a tumour, treat bleeding or repair a blood vessel. The bone is replaced at the end of the operation.
- Awake craniotomy: for some tumours close to areas that control speech or movement, part of the operation is done while you are awake and comfortable, so that the surgical team can check these functions as they work.
- Deep brain stimulation (DBS): fine electrodes are placed deep in the brain to help conditions such as Parkinson's disease, tremor or dystonia. A small battery device is then placed under the skin of the chest.
Some neurosurgical problems can be treated without opening the skull, using catheters guided by X-ray. These are described on the Interventional Radiology page.
The role of your specialist anaesthetist
During brain surgery my role goes beyond keeping you asleep and pain-free. I manage your blood pressure, breathing, oxygen and carbon dioxide levels closely, because each of these affects blood flow to the brain and the pressure inside the skull. I work with the neurosurgeon throughout so that the surgical conditions are as good as possible and your brain is protected.
For awake procedures, I am also there to keep you comfortable, calm and safe, and to talk with you during the parts of the operation when you are awake.
Common anaesthetic approaches
- General anaesthesia is used for most craniotomies. Often this is total intravenous anaesthesia (TIVA), given entirely through a drip, which allows a smooth, controlled wake-up so that you can be assessed quickly afterwards.
- Awake craniotomy combines local anaesthetic to numb the scalp with carefully titrated sedation. You are drowsy and comfortable during the opening and closing stages, and more alert for the testing stage. Oxygen is usually given through a soft nasal tube, sometimes as warmed, high-flow oxygen.
- Deep brain stimulation may be done awake with sedation, asleep under general anaesthesia, or as a combination, depending on the technique your neurosurgeon uses and what suits you.
Not every technique is right for every patient. For example, an awake operation needs a patient who feels able to lie still and communicate, and it is not suitable for everyone. We will talk through what is planned and why.
Preoperative assessment and preparation
I will review your general health, the effects of your neurological condition, your medications and any previous anaesthetic experiences. Some medications, including anti-seizure medicines and steroids, are usually continued, while others such as blood thinners need an individual plan agreed with your neurosurgeon. Please do not stop or change any medication unless your anaesthetist, surgeon or prescribing doctor has advised you to. More detail is on Medications Before Anaesthesia.
If you are having an awake procedure, I will explain each stage beforehand, including what you will feel, hear and be asked to do. Knowing what to expect makes a real difference. Please ask as many questions as you need.
What happens during the procedure
Once you are asleep, or comfortable for an awake procedure, additional monitoring is usually placed. This often includes an arterial line, a fine tube in an artery at the wrist that measures blood pressure with every heartbeat, and sometimes a line in a larger vein. A urinary catheter is common for longer operations. Your head is held still in a frame, and your eyes, skin and pressure points are protected.
Brain protection is central to the anaesthetic. It includes careful control of blood pressure, breathing and body temperature, positioning to help blood drain from the head, and medications that reduce brain swelling when needed.
Recovery and postoperative considerations
After brain surgery, most people are cared for in an intensive care unit (ICU) or high-dependency unit (HDU) for at least the first night. This allows nurses to check your level of alertness, strength, speech and pupils frequently. A headache and some nausea are common and are treated. Many people are surprised by how manageable the pain is. The length of your hospital stay depends on the operation and your recovery. General information is on Recovery & Aftercare.
Relevant anaesthetic risks and precautions
The common side effects of anaesthesia, such as nausea, sore throat and tiredness, also apply here. Risks specific to anaesthesia for brain surgery include changes in blood pressure, swelling of the brain, seizures, and occasionally a slower wake-up that needs a longer period of breathing support. During awake surgery, some people feel uncomfortable or anxious; if this happens, sedation can be adjusted or, if needed, a general anaesthetic can be given.
Surgical risks, such as bleeding, stroke or new neurological symptoms, will be discussed with you by your neurosurgeon. I will discuss the anaesthetic risks that matter for you. See Anaesthetic Safety & Risks for how often complications occur and how they are reduced.
Links to additional patient resources
- Preparing for Your Procedure
- Understanding Your Anaesthetic & Informed Consent
- Medications Before Anaesthesia
- Recovery & Aftercare
- About anaesthesia, Australian and New Zealand College of Anaesthetists (ANZCA)