Neuro Oncology - Post Craniotomy/Biopsy Care - Discharge Advice

Wound care and hair hygiene

We request you wash your hair ______ days after surgery then daily until your sutures or surgical clips are removed.

Use a mild shampoo, baby shampoo is ideal, clean around the wound area with the palm of your hand not the fingertips. Do not use a hair dryer.

We would advise you to not colour or bleach your hair for six weeks after surgery. It is safe for you to have your hair cut/styled once the sutures/clips are removed.

Please contact your specialist nurse team if you notice any of the following symptoms:

• Discharge from the wound – clear fluid or bleeding
• Increased pain or swelling around the wound
• Feeling unwell or have a temperature

Steroids (Dexamethasone)

You will be discharged usually on a weaning course of steroids. The pharmacist will provide you with a sheet of instructions for the doses and dates to take the reducing dose.

If you begin to experience worsening symptoms, such as headaches, difficulty with mobility, balance or speech problems, please seek advice from your Specialist Nurse.

Medications

Dexamethasone – steroid
Omeprazole or Lanzoprazole – a proton pump inhibitor to protect your stomach from the steroids

Blood glucose control while taking steroids

It is important to be aware of your blood glucose levels while you are taking steroids.

Symptoms that may indicate your blood glucose level is out of range are:

• Excessive thirst
• Increased need to pass urine

Please see your GP if you notice any of these symptoms.

It may be noted during your admission that your blood glucose is raised this can be managed with additional medication and we may provide you with a blood glucose monitor to go home with to monitor yourself with training.

Long term steroid use can also have the following effects:

• Dry mouth
• Muscle wasting
• Proximal myopathy (aching upper thighs when rising the stairs or getting up from a chair)
• Steroid induced psychosis

Seizures

You may have already experienced seizures and be taking medication to control them.

You may have a short course of anti-seizure medication for two weeks following your surgery.

Types of seizures

Patients with brain tumours most commonly experience:

• Focal aware or simple partial seizures, limb or facial twitching/ sensory change
• Focal impaired or complex partial: confusion, speech disturbance, new agitation/aggression
• Generalised tonic clonic seizures (Grand mal) which could involve incontrollable jerking of all limbs, loss of consciousness and often incontinence

Common symptoms include

• Aura (feeling of dread)
• Strange taste (metallic)
• Changes in movement or sensation in a limb or face, feelings of déjà vu, a ‘rising’ feeling from the feet or stomach
• Tongue clicking, lip smacking, fidgeting, difficulty with speech, confusion

For more information about seizures please visit:

www.Epilepsy.org

https://www.thebraintumourcharity.org/living-with-a-brain-tumour/side-effects/seizures-epilepsy-and-brain-tumours/

Seizure medication and common side effects

• Lamotrigine - rash occurring in the first 8 weeks of starting the drug, agitation, nausea
• Levetiracetam - anxiety, mood disturbance, decreased appetite
• Sodium valproate - should be avoided in women of childbearing age, agitation abdominal pain
• Clobazam - decreased appetite, dry mouth

First Aid

Most seizures will resolve themselves within a few minutes.

DO’s

• Do stay with them. Be calm and reassuring
• Do ensure their safety by moving objects and/or furniture away from the person having a seizure so that they don’t injure themselves
• Do time the seizure and call for emergency help especially if the seizure lasts more than 5 minutes, or if there are repeated seizures, or if the person is injured or has difficulty breathing
• Do make the individual comfortable when the seizure stops
• Do consider turning the person on their side, into the recovery position, after the seizure has stopped, during the period of recovery
• Do expect to find that the person who has had the seizure will be confused, disorientated and tired afterwards (this is known as the 'post ictal phase)

DO NOT

• Do NOT try to hold someone down when they’re having a seizure
• Do NOT try to put anything in the mouth of someone having a seizure

Many of the epilepsy charities have a wealth of information for people with newly diagnosed seizures.
www.epilepsy.org.uk - Epilepsy Action
www.epilepsysociety.org.uk - The Epilepsy Society
www.epilepsy.com - The Epilepsy Foundation

Managing fatigue and exercise

It is normal for you to experience fatigue for several weeks following surgery.

Gentle exercise is encouraged, start with short sessions and build up as your energy level allows.

Rest as required.

You can go swimming once your wound is healed. If you have experienced seizures, ensure the pool has a lifeguard or are swimming with a strong experienced swimmer.

Driving

You are advised not to drive following your surgery and inform the DVLA.

The length of time you will be unable to drive for will depend on a number of factors:

• Whether you had any seizures
• What your tumour is (histology)
• Whether you require further treatment
• Your consultant/specialist nurse will let you know at your follow up appointment