Brain Tumor Surgery and Post-Operative Care Challenges

Brain Tumor Treatment

Hello, doctor.
On March 28, the patient underwent surgery to remove a brain tumor approximately 5.5 cm in size located in the left ventricle.
Postoperatively, the patient was stable and was able to open their eyes and recognize people after the anesthesia wore off.
On March 31, due to intracranial pressure rising above 25, the patient underwent a second surgery for craniotomy to relieve the intracranial pressure and replace the drainage tube (as the tumor was compressing the tube, causing poor drainage).
The Glasgow Coma Scale score was between 5 and 6.
A week later, another drainage tube surgery was performed (creating a hole in the skull, with the tube draining through subcutaneous tissue from the chest).
As of April 17, the Glasgow Coma Scale score remained between 5 and 6, vital signs were stable, and intracranial pressure was maintained below 20 without fever.
The patient exhibited involuntary yawning and coughing, with more significant responses in the left limbs compared to the right.
There was a change in pupillary response to light from none to some (with involuntary eye movements).
I would like to hear the opinions of other surgeons regarding the following questions:
1.
Since the patient has been in the intensive care unit for 21 days, is it appropriate to transfer them to a respiratory rehabilitation center given their comatose state? (It seems the brain condition has not fully healed, and I am concerned about how to train breathing in a comatose patient.) Is the transfer due to health insurance policies, meaning the patient must leave the ICU regardless of their level of consciousness or awareness?
2.
In similar situations, what is the typical duration for awakening? (The physician indicated that the patient would awaken but did not specify how long, suggesting the family should wait, etc.)

Niming, 30~39 year old female. Ask Date: 2016/04/17

Dr. Zhang Junwei reply Neurosurgery

1.
Yes, if the patient's condition is stable, they should be transferred from the intensive care unit (ICU) to a general ward for further treatment, even if they have not regained consciousness.
If patients could remain in the ICU indefinitely just because they haven't woken up, all ICUs in Taiwan would be overwhelmed! This is mandated by the National Health Insurance regulations.
2.
It's hard to say; there is no guarantee that they will wake up.

Reply Date: 2016/04/17

More Info

Understanding the complexities of brain tumor surgery and the subsequent challenges in post-operative care is crucial for both patients and caregivers. The case you presented involves a patient who underwent surgery to remove a significant brain tumor, followed by complications that necessitated additional procedures to manage increased intracranial pressure. Here, I will address your concerns regarding the patient's condition and the implications for post-operative care.

1. Transitioning from ICU to Rehabilitation: The decision to transfer a patient from the Intensive Care Unit (ICU) to a rehabilitation center, even if they remain in a comatose state, is often influenced by hospital policies and healthcare regulations, including insurance guidelines. In many healthcare systems, including the U.S., there are strict criteria for ICU admissions, and once a patient is stable, they may be moved to a less intensive care setting. This transition does not necessarily reflect the patient's readiness to engage in rehabilitation but rather the need to optimize resource allocation within the hospital.

For a patient in a comatose state, the appropriateness of moving to a respiratory training center depends on their overall medical condition and the potential for recovery. While it may seem premature to initiate respiratory training, rehabilitation specialists can often work with patients in various states of consciousness. Techniques may include passive range-of-motion exercises and respiratory therapy to maintain lung function and prevent complications such as pneumonia. However, the effectiveness of such interventions can vary significantly based on the patient's neurological status.

2. Duration of Coma and Recovery Expectations: The duration of a coma and the timeline for awakening can be highly variable and depend on numerous factors, including the extent of brain injury, the patient's age, overall health, and the specific nature of the surgical intervention. While some patients may regain consciousness within days, others may take weeks or even months. The Glasgow Coma Scale (GCS) score you mentioned (5-6) indicates a severe level of impairment, and while some patients do recover from such states, predicting the exact timeline is challenging.

It is essential for family members to maintain open communication with the medical team. Regular assessments and updates can provide insights into the patient's progress and potential for recovery. Engaging with neurologists and rehabilitation specialists can also help in understanding the prognosis and setting realistic expectations.

In summary, navigating the post-operative landscape following brain tumor surgery involves understanding the medical, emotional, and logistical challenges that arise. Caregivers play a vital role in advocating for the patient’s needs and ensuring they receive appropriate care. It is advisable to seek out resources such as support groups, educational materials on brain injury recovery, and consultations with specialists in neurorehabilitation to better equip yourself for the journey ahead. The complexities of brain recovery can be daunting, but with the right support and information, caregivers can significantly impact the patient's recovery trajectory.

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