What is Open Brain Surgery?

Open brain surgery is a surgical treatment method that allows direct surgical intervention on the affected area of the brain. This procedure is performed by creating a surgical opening in the skull to directly visualize the brain tissue and treat it when necessary. Open brain surgery plays an important role in the treatment of various health problems that require access to the depths of the brain, especially in cases such as large tumors, vascular occlusions, brain hemorrhages, aneurysms, and head trauma.

During open brain surgery, the procedure is performed with precision using microscopic instruments and advanced technology-supported equipment. Intervening in the correct area without damaging brain tissue requires a high level of expertise. Thanks to advances in technology, open brain surgery procedures have become much safer. New generation imaging technologies, neuronavigation systems, and microsurgical techniques allow surgeons to navigate more accurately within the brain. These technologies help surgeons intervene in the correct area more quickly and safely. In addition, patients' post-operative recovery times are significantly reduced.

Open brain surgery plays a life-saving role, especially in brain diseases requiring urgent intervention. Surgical treatment of brain tumors, vascular occlusions, and aneurysms can prevent life-threatening complications in advanced cases. During open brain surgery, the operation process is managed in a highly controlled manner with the careful protection of the brain membranes, the use of microsurgical techniques, and the support of advanced imaging systems.

The treatment plan and recovery process following open brain surgery are particularly important in terms of improving the patient's quality of life. When performed with the correct indications, this surgical method helps eliminate harmful structures in the brain tissue and preserve brain function.

Why is Open Brain Surgery Performed?

Open brain surgery is a very important surgical intervention performed to treat serious health problems that threaten the structure or functions of the brain. It is a method frequently used in the treatment of progressive and life-threatening diseases that require access to the depths of the brain and do not respond to medication. The primary goal of the surgery is to improve the patient's quality of life and save their life by removing structures that disrupt or threaten brain functions.

Open brain surgery can be performed using many different surgical techniques available in modern medicine. Microsurgery, neuronavigation systems, high-resolution imaging technologies, and microscopic surgery are technologies frequently used in such operations. Open brain surgery is generally performed for severe brain-related health problems, and this operation is critically important in terms of saving vital functions.

Open brain surgery is usually preferred for brain diseases that cannot be controlled with drug treatment, pose a high level of risk, and create a life-threatening situation. These types of diseases progress over time and, if left untreated, can further worsen the patient's quality of life and ultimately lead to fatal consequences.

When Is Open Brain Surgery Necessary?

Open brain surgery may be necessary for a variety of health conditions. The brain is a very sensitive organ, and any disease or problem can affect its normal functioning. Therefore, open brain surgery can be performed to treat many conditions that threaten the health of the brain.

The necessity for open brain surgery may arise in the following situations:

Brain tumors (benign or malignant)

Brain tumors can cause serious health problems due to the uncontrolled growth of brain tissue. Tumor growth can disrupt brain functions by putting pressure on surrounding tissues. The spread of cancerous cells to brain tissue may require surgical intervention. Open brain surgery ensures that tumors are removed correctly.

Brain hemorrhages

Brain hemorrhages can occur due to head trauma, blood vessel rupture, or high blood pressure. Hemorrhages in the brain can seriously disrupt brain functions and require urgent intervention. Open brain surgery allows direct intervention in the hemorrhage area and prevents brain damage.

Aneurysm (vascular ballooning)

Ballooning of the brain vessels carries the risk of rupture, leading to a brain hemorrhage. When rupture occurs, serious damage to the brain occurs. Open brain surgery to clip these aneurysms helps prevent rupture.

Arteriovenous malformation (AVM)

Congenital abnormalities in the blood vessel structures of the brain can pose a risk of bleeding. AVMs can also cause neurological problems. These abnormalities can be corrected with open brain surgery, preventing the risk of bleeding and neurological problems.

Brain trauma

Traumas such as skull fractures, blood accumulations (hematomas), or foreign objects can seriously affect brain function. In such cases, open brain surgery is performed to relieve the pressure on the brain.

Drug-resistant epilepsy

Epilepsy seizures sometimes cannot be controlled with medication. The source of the seizures may be specific areas in the brain tissue. Open brain surgery can improve patients' quality of life by eliminating the source of the seizures.

Pressure caused by masses, cysts, or infections

Cysts or infections in the brain can compress brain tissue, leading to loss of function. Open brain surgery can remove these masses or infections, thereby preserving brain function.

The Primary Goals of Open Brain Surgery

Open brain surgery is performed to treat diseases that have harmful effects on the brain. The main purpose of this surgery should be to eliminate diseases that threaten brain function, reduce pressure, and restore healthy brain function. Open brain surgery is performed with the following goals:

To reduce pressure on the brain: Tumors, bleeding, or other diseases within the brain can cause pressure on brain tissue, leading to loss of function. Open brain surgery is performed to eliminate this pressure.

Repairing damaged tissue: Damage to brain tissue can lead to more serious problems over time. Open brain surgery repairs this damaged tissue and initiates the healing process.

Stopping bleeding: Bleeding in the brain can be life-threatening. Open brain surgery is used to intervene in the area of bleeding and stop it.

Removing tumors or masses: Tumors or cysts in the brain can seriously threaten the patient's health. Open brain surgery removes these structures, protecting brain function.

Preserving vital functions: The patient's quality of life is improved by preserving brain functions. Open brain surgery is particularly necessary for life-threatening diseases.

Stopping the progression of neurological problems: Neurological problems in the brain can cause permanent damage if left untreated. Open brain surgery controls these problems and stops their progression.

Open brain surgery is a life-saving intervention in serious cases that threaten the structure of the brain. This surgical procedure, performed to restore brain function and protect the patient's health, is an extremely delicate operation that requires expertise.

Types of Open Brain Surgery

Open brain surgery can be performed using different techniques depending on the purpose of the intervention, the affected area of the brain, and the type of disease. Each type of surgery involves specific approaches to a particular problem. Today, thanks to microsurgery, neuronavigation, and advanced imaging systems, these operations have become much safer.

The most commonly performed types of open brain surgery are listed below in a user-friendly and understandable manner:

1. Craniotomy

Craniotomy is the most common type of open brain surgery, involving the temporary removal of a bone fragment from the skull to access the brain. When is it performed?

• Brain tumors
• Aneurysms
• AVM (arteriovenous malformation)
• Trauma-related bleeding
• Drug-resistant epilepsy

2. Craniectomy

Similar to craniotomy, but the removed bone fragment is not replaced at the end of the procedure. When is it preferred?

• When there is severe brain edema,
• When pressure increase needs to be controlled,
• When post-traumatic brain swelling threatens life.

3. Tumor Resection Surgeries

These are surgical procedures performed to remove brain tumors. Techniques used:

• Microsurgery
• Awake surgery (awake brain surgery)
• Laser-assisted tumor removal
• Neuronavigation-assisted surgery

4. Aneurysm Clipping Surgery

This procedure involves placing a titanium clip at the base of the aneurysm to prevent the ballooned section of the brain vessel from rupturing. What does it provide?

• It eliminates the risk of aneurysm bleeding.
• It stops the spread of existing bleeding.

5. AVM (Arteriovenous Malformation) Surgery

This is a surgical procedure performed to remove or correct a vascular malformation. When is it performed?

• In AVMs with a high risk of bleeding,
• When it causes epilepsy that cannot be controlled with medication.

6. Hematoma Drainage Surgery

This procedure involves draining blood accumulations that form after head injuries or vascular tears. When is it necessary?

• Loss of consciousness
• Life-threatening increase in brain pressure
• Severe headache and neurological deficits

7. Epilepsy Surgery

In patients with drug-resistant epilepsy, the area causing seizures is surgically removed. Techniques used:

• Focal resection
• Temporal lobe surgery
• Corpus callosotomy

How is Open Brain Surgery Performed?

Open brain surgery is a detailed process performed step by step by a team of expert neurosurgeons using high-tech equipment. This process is meticulously planned to ensure patient safety and increase the success rate of the surgery. Open brain surgery is a critical procedure that allows direct intervention in the affected area of the brain. Below, we explain how the open brain surgery process is generally performed and how each stage is meticulously managed.

1. Preoperative Preparation

Before open brain surgery begins, the patient's health status is comprehensively evaluated. This stage is crucial for the success of the open brain surgery process. During this preparation phase:

• Brain MRI and CT scans are performed: The problematic area in the brain is identified.
• Blood tests and anesthesia evaluation: The patient's general health is checked, and their suitability for anesthesia is assessed.
• Surgery planning with neuronavigation system: A map of the brain is created to ensure that the surgeon intervenes in the correct area.
• Patient education about the surgery: Detailed information about the operation is provided to prepare the patient for the process.

The goal is to ensure that the surgeon can safely reach the problem area within the brain during open brain surgery.

2. Anesthesia Administration

Open brain surgery is usually performed under general anesthesia. However, in some cases, especially in tumor and epilepsy surgeries, the patient may be kept awake. In such surgeries, the awake surgery method is preferred. This method allows for the preservation of speech, movement, and brain functions. Keeping the patient conscious during open brain surgery helps the surgeon perform the procedure while preserving neurological functions.

3. Preparation of the Scalp and Incision

During open brain surgery, the surgeon sterilizes the surgical area and makes an incision in the scalp in the planned area. This incision is planned aesthetically to match the natural lines of the scalp. The scalp is carefully opened during the surgery and will be closed again later.

4. Craniotomy (Opening the Skull Bone)

Craniotomy is the temporary removal of a piece of bone from the skull during open brain surgery. This step allows the surgeon to safely access the affected area of the brain. This part of the open brain surgery process is a very delicate procedure. At the end of the procedure, the bone fragment is secured in place with special plates and screws.

5. Accessing Brain Tissue and Microsurgical Procedures

The surgeon advances toward the brain surface using a microscope and special micro instruments. Reaching the brain tissue and performing the correct intervention during open brain surgery is a step that requires great precision. The procedures performed at this stage vary depending on the purpose of the surgery:

• If there is a tumor, it is removed: Tumors in the brain are removed using microsurgical techniques.
• If there is an aneurysm, it is clipped: Ballooning of the brain vessels is prevented.
• If there is an AVM (Arteriovenous Malformation), the vascular tangle is cleaned: Abnormalities in the blood vessels in the brain are corrected.
• If there is a hematoma, the blood is drained: Blood accumulations in the brain are cleaned up.
• If there is an epileptic focus, the responsible area is removed: The area causing epileptic seizures is removed.

The surgeon uses neuronavigation and neuromonitoring systems to track the brain map in real time during open brain surgery, ensuring the procedure is performed correctly and safely.

6. Bleeding Control and Closure

Once the entire procedure is complete, the surgeon stops the bleeding, closes the brain membranes, and secures the skull bone back into place. During open brain surgery, minor vascular bleeding is carefully controlled. Finally, the scalp is closed with cosmetic sutures.

7. Intensive Care and Postoperative Monitoring

After open brain surgery, patients are usually monitored in intensive care for a period of time. During this process, brain functions, risk of bleeding, signs of infection, and level of consciousness are closely monitored. The postoperative follow-up process is very important in order to speed up the patient's recovery and prevent complications.

Although these steps are generally similar for all types of open brain surgery, the details of the operation are determined by the patient's overall condition and the affected area of the brain.

Post-Open Brain Surgery Recovery Process

The recovery process after open brain surgery varies depending on the type of operation, the area of the brain involved, the patient's general health, and the reason for the surgery. However, in general, the process consists of several stages: intensive care, hospital stay, home care, and long-term recovery. This period requires both physical and mental recovery, so regular follow-up and patient process management are important.

1. First 24–48 Hours: Intensive Care Period

Immediately after surgery, patients are admitted to the intensive care unit. The following conditions are monitored during this phase:

• Level of consciousness
• Respiratory functions
• Intracranial pressure
• Risk of bleeding or edema
• Signs of infection

The intensive care period varies between 1–2 days in most patients, but may be longer in some severe cases.

2. Hospital Admission Process

Patients discharged from intensive care are admitted to the ward. This period usually lasts between 3–10 days.

Activities during this process:

• Pain management
• Wound monitoring
• Neurological examinations
• Movement, balance, and speech assessments

Supportive treatments such as physical therapy and speech therapy can be started early if necessary.

3. Home Recovery Period

After discharge, the patient's recovery process continues at home. This process can typically vary from a few weeks to a few months.

Important considerations at home:

• Regular use of medications prescribed by the doctor,
• Keeping the suture area clean,
• Seeking medical attention immediately if experiencing severe symptoms such as sudden severe headache, vomiting, or changes in consciousness,
• Avoid heavy lifting, bending, and strenuous activities.

Mild fatigue, changes in sleep patterns, and difficulty concentrating are considered normal during this period.

4. Rehabilitation and Functional Recovery

Some patients may require additional supportive therapies after surgery.

Rehabilitation methods:

• Physical therapy: Recovery of walking, balance, and muscle strength.
• Speech therapy: Restoring language and speech functions.
• Neuropsychological support: Memory, attention, and mood regulation.

These supports significantly accelerate recovery, especially in cases of tumor, stroke, trauma, or epilepsy surgery.

5. How Long Does Full Recovery Take?

The recovery time varies for each patient, but the general framework is as follows:

• Initial recovery: 2–6 weeks
• Return to daily life: 1–3 months
• Full recovery and normalization of brain functions: 6–12 months

In some patients, this period may be shorter or longer. The location of the surgery, which areas of the brain were affected, and the patient's age are the main factors influencing this process.

Post-Open Brain Surgery Complaints

It is quite normal to experience some temporary complaints after open brain surgery. Surgical intervention on the brain and surrounding tissues can cause various reactions during the body's natural healing process. Most of these complaints diminish over time and disappear completely. However, some symptoms should be monitored carefully as they may be signs of more serious problems.

1. Headache

Headache is one of the most common complaints following open brain surgery. Why does it occur?

• Healing at the surgical site,
• Sensitivity in the brain membranes,
• Sutures on the scalp. (These usually subside within a few weeks.)

2. Fatigue and Weakness

After brain surgery, the body's energy needs increase. Therefore, patients may experience:

• Quick fatigue,
• Sleepiness,
• Low energy levels during the day.

This is a natural part of the recovery process.

3. Concentration and Memory Problems

Temporary distractibility, forgetfulness, and difficulty concentrating are particularly common in the first few weeks. These symptoms usually improve over time and can be quickly alleviated with neuropsychological support if necessary.

4. Nausea and Vomiting

These symptoms are usually:

• The effects of anesthesia,
• Postoperative medications,
• Changes in brain pressure.

The symptoms subside within a few days.

5. Dizziness and Balance Problems

May occur after surgery performed near the cerebellum or balance centers. Physical therapy accelerates the improvement of these symptoms.

6. Numbness or Tingling in the Scalp

Since the nerves in the surgical area take time to heal, patients may experience:

• Numbness,
• Tingling,
• A slight stinging sensation. This complaint is usually temporary.

7. Vision or Speech Problems

Depending on the area operated on, temporary speech disorders or blurred vision may occur. These conditions usually subside within a few weeks.

Serious Symptoms to Watch For

Some symptoms are not normal and require immediate attention:

• Severe and persistent headache
• Confusion
• High fever
• Increasing vomiting
• Worsening speech impairment
• Weakness in the arms or legs
• Severe redness or inflammation at the suture site

These symptoms may indicate risks such as brain hemorrhage, infection, or brain edema, and immediate medical attention is required.

Risks of Open Brain Surgery

Although open brain surgery has become much safer today thanks to advances in technology and modern surgical techniques, it carries certain risks, as with any major surgical procedure. These risks may vary depending on the patient's general health, the area of the brain where the surgery is performed, and the type of operation. Although most of these risks are rare, it is important for patients to be informed about them before surgery.

1. Infection Risk

As with any surgical procedure, there is a risk of infection in open brain surgery. Possible types of infection include:

• Brain membrane infection (meningitis)
• Surgical site infection
• Redness and discharge on the scalp

This risk is minimized through sterile surgical environments and antibiotic treatments.

2. Brain Hemorrhage

Brain hemorrhage may occur during or after surgery due to damage to blood vessels. Although this condition is rare, it may require urgent intervention.

3. Brain Edema (Swelling)

Temporary swelling of the brain tissue may occur after surgery. This condition:

• Headache,
• Nausea,
• Changes in consciousness. It is usually managed with medication.

4. Loss of Neurological Function

The area of the brain that was operated on may be responsible for important functions such as speech, movement, balance, or vision. Therefore, some patients may experience temporary or permanent problems:

• Speech impairment
• Weakness in the arms or legs
• Balance problems
• Vision loss or blurred vision

Microsurgery and neuronavigation systems significantly reduce these risks.

5. Development of Seizures (Epilepsy)

Some patients may experience new epileptic seizures after surgery. These can usually be controlled with medication.

6. Cerebrospinal Fluid (CSF) Leak

CSF leakage may occur if the brain membranes in the surgical area do not close completely. This is rare and is usually treated with non-surgical methods.

7. Anesthesia-Related Risks

As with any major surgery, open brain surgery carries certain risks associated with anesthesia:

• Allergic reaction
• Respiratory problems
• Heart rhythm disorders

These risks are minimized through a detailed anesthesia assessment prior to surgery.

How Are Risks Reduced?

• An experienced neurosurgery team,
• Advanced imaging and navigation systems,
• Microscopic surgical techniques,
• Regular post-operative follow-up,
• The patient's adherence to medication and care recommendations all help minimize these risks.