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CONSENT INFORMATION - PATIENT COPY CRANIOTOMY

PLEASE READ THIS SHEET BEFORE YOU CONSENT TO YOUR SURGERY


This information sheet provides general information to a person having a Craniotomy. It does not provide advice to the individual. It is important that the content is discussed between you and your doctor who understands your level of fitness and your medical condition.

What is a Craniotomy? A craniotomy is an operation to open the head in order to expose the brain. The word craniotomy means making a hole (-otomy) in the skull (cranium). This operation is carried out in hospital by a neurosurgeon who has specialized in surgery of the brain and spinal cord. Why do I need a craniotomy? A craniotomy is necessary to deal surgically with a number of abnormalities of the brain and its surrounding structures. The following are a few examples of the types of condition for which a craniotomy is commonly carried out. Severe head injury which results in a blood clot pressing on the brain. If the blood clot is formed between the membranes surrounding the brain, it is known as a subdural hematoma. If the blood clot is between the inside of the skull and the outer membrane covering the brain, it is known as an extradural hematoma.

A growth or tumor arising either from the membranes surrounding the brain (e.g. a meningioma) or from within the brain (e.g. a glioma). Any such growth can cause pressure on the brain. Bleeding inside or on the surface of the brain caused by leakage from abnormal blood vessels, e.g. subarachnoid hemorrhage. What happens if I dont get it operated? If left untreated, any condition requiring brain surgery can cause further damage to the brain. Pressure on the brain can be harmful as it forces the brain against the skull, causing damage as well as hampering the brains ability to function properly. This drop in function can lead to long-lasting brain damage or even death. Will it hurt? The operation is usually carried out under a general anesthetic. You will be asleep and will not feel anything. In some cases, the surgeon will suggest that the operation is carried out under local
MSSH/Physician/Consent Craniotomy/Ver.1/Oct.2007

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anesthetic. Sometimes it will be necessary to shave a small section of the head. What happens during the procedure? The place, size and shape of the skin incision vary according to the type of operation. The incision is usually placed behind the hairline to hide the scar although this is not always possible. The scar will fade to a pale thin line within three to six months and the hair will usually grow back normally where it has been shaved. To gain access to the brain a small section of the skull is temporarily removed. The precise location of the opening is decided after careful consideration of brain scans and other investigations that have been carried out before the operation. Once the opening has been made, the lesion (abnormal tissue or growth) is then removed or treated. After the surgery has been completed, the bone is then replaced to cover the hole that has been made. The bone is usually fixed with strong stitches or small miniplates to prevent movement and encourage safe and strong healing. What will happen after the operation?

monitor your progress very closely. If everything remains stable, you will be transferred back to the ward. Occasionally, if intensive monitoring is required after the operation, you may be transferred to an intensive therapy unit. You may then be kept asleep on a breathing machine for a period after the operation to allow your brain to recover. If this is likely to be necessary, your surgeon will discuss it with you before the operation takes place. Once you have been transferred back to the ward, you will be observed and monitored carefully. You will be given fluids through a drip into your vein. You may also have a drain to remove any fluid oozing from the wound. Sometimes a fine tube (catheter) is placed into the bladder to help you pass urine. All of these tubes will gradually be removed as your condition improves. What are the possible after effects of

craniotomy? (a) Problems that can occur shortly after the operation: Occasionally, a blood clot may form at the site of the operation. If this happens, depending on its size, you may need a second operation to remove it. However, this is a rare complication. After brain surgery there is is small risks

You will usually be woken up as soon as the operation is over. You will regain consciousness in the recovery area where special nurses
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of developing fits (epileptic seizures).To prevent this, anti-epilepsy medication sometimes

MSSH/Physician/Consent Craniotomy/Ver.1/Oct.2007

prescribed for some months following the operation. (b) Problems that can occur later on: During a craniotomy a small cut is sometimes made to the muscle that helps with chewing. As it heals after the operation, the muscle can become slightly shorter, causing the jaw to feel stiff. Chewing gum helps to resolve this problem, which usually clears up after a couple of months. As the wound in your head heals, it may feel painful at first. This gradually improves and is usually better by the time the stitches are removed, three to five days after the operation. Some surgeons use stitches that dissolve and do not need to be removed. Later on, the skin around the edges of the wound may feel a bit numb until the healing is complete. This numbness may itself be painful or unpleasant for a while. Wound infection is not usually a problem and in order to prevent it, you will often be treated with antibiotics around the time of the operation. How long does recovery take? Recovery time depends on the underlying condition and on whether there were any complications during or after the operation. Normally, you can expect to stay in hospital for five to 10 days and rest at home for a further six to 12 weeks. For people who have problems
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related to their underlying condition, there may be a need for a longer hospital stay and further care in a rehabilitation unit. How will life be affected after a craniotomy? You are advised to avoid flying for ten days after a craniotomy. Up until six weeks after the operation you should inform the airline you are traveling with and your insurance company about the operation. Contact sports such as boxing or rugby should be avoided after any brain operation. Swimming is fine once the wound has healed, but it is a good idea to be accompanied for the first few months because of the risk of fits occurring. The timing of a return to work and other activities will need to be discussed with the doctor responsible for your care. Sexual intercourse is safe once you have recovered from the operation. Small amounts of alcohol are safe, although you are likely to be more susceptible to its effects. There is a risk of provoking a fit if you have too much to drink. Some people who have had a craniotomy have found that they have more severe hangovers if they drink alcohol. After the surgery contact your Doctor if: You develop a fever over 100F (37.8C). You become dizzy or faint. You have nausea and vomiting. You have chest pain. You become short of breath.

MSSH/Physician/Consent Craniotomy/Ver.1/Oct.2007

Expectations from the surgery: Although having a craniotomy is a significant procedure, modern surgical techniques and specialized after care mean that most people make a good recovery and can get back to their normal lives within a few weeks of the operation. General Risks of having an Operation: These have been mentioned in the Anesthesia Consent Form. Please discuss this with your Anesthetist before signing the Anesthesia Consent Form. What are the risks of the procedure? While may majority be of patients with have an

(c) Leakage of brain fluid (cerebro-spinal fluid) through the wound. This may require further surgery. (d) Stroke or stroke - like complications which can cause weakness in the face, arms and/ or legs. This may be temporary or permanent. (e) Epilepsy which may require medication. This may be temporary or permanent. (f) Loss of vision which may be temporary or permanent. (g) The lesion may not be cured by surgery and may need further treatment. (h) Increased risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis. (i) Increased risk in smokers of wound and chest infections, thrombosis. 10. Consent Acknowledgement: The doctor has explained my medical condition and the proposed surgical procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes. The doctor has explained other relevant treatment options and their associated risks, the prognosis and the risks of not having the procedure. I have been given an Anesthesia Informed Consent Form. I have been given a Patient Information Sheet about the Condition, the Procedure, and associated risks. heart and lung complications and

uneventful surgery and recovery, few cases associated complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below: (a) Infection of the skin and/ or bone. This may require further surgery. (b) Bleeding which may require a blood transfusion and may result in brain damage. This may be permanent.

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MSSH/Physician/Consent Craniotomy/Ver.1/Oct.2007

I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction. I understand that the procedure may include a blood / blood product transfusion. I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital. The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated as appropriate. It has been explained to me, that during the course of or subsequent unforeseen to the Operation/Procedure, conditions

in addition to or different from those contemplated. In such exigency, I further request and authorize the above named Physician / Surgeon or his designee to perform such additional surgical or other procedures as he or they consider necessary or desirable. On the basis of the above statements, I REQUEST TO HAVE THE PROCEDURE. Name of Patient/Substitute Decision Maker. Relationship . Signature Date Name of the Witness Relationship/Designation Signature.. Date REFERENCES

may be revealed or encountered which may necessitate urgent surgical or other procedures

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MSSH/Physician/Consent Craniotomy/Ver.1/Oct.2007

INFORMED CONSENT: CRANIOTOMY


Patient identification label to be affixed here

A. INTERPRETER An interpreter service is required Yes____No_______

If Yes, is a qualified interpreter present Yes_____No______ B. CONDITION AND PROCEDURE The doctor has explained that I have the following condition: (Doctor to document in patients own words) and I have been advised to undergo the following treatment/ procedure........................................ . See patient information sheet-Craniotomy for more C.ANAESTHETIC Please see your Anesthesia Consent Form. This gives you information of the General Risks of Surgery. If you have any concern, talk these over with your anesthetist. OPERATION: To gain access to the brain a small section of the skull is temporarily removed. The precise location of the opening is decided after careful consideration of brain scans and other investigations that have been carried out before the operation. Once the opening has been made, the lesion (abnormal tissue or growth) is then removed or treated. After the surgery has been completed, the bone is then replaced to cover the hole that has been made. D.RISKS OF THIS PROCEDURE
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While majority of patients have an uneventful surgery and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below: (a) Infection of the skin and/ or bone. This may require further surgery. (b) Bleeding which may require a blood transfusion and may result in brain damage. This may be permanent. (c) Leakage of brain fluid (cerebro-spinal fluid) through the wound. This may require further surgery. (d) Stroke or stroke - like complications which can cause weakness in the face, arms and/ or legs. This may be temporary or permanent. (e) Epilepsy which may require medication. This may be temporary or permanent. (f) Loss of vision which may be temporary or permanent. (g) The lesion may not be cured by surgery and may need further treatment. (h) Increased risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis. (i) Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis. E.SIGNIFICANT RISKS AND RELEVANT TREATMENT OPTIONS The doctor has explained any significant risks and problems specific to me, and the likely outcomes if complications occur. The doctor also has explained relevant treatment options as well as the risks of not having the procedure. (Doctor to document in medical record if necessary. Cross out if not applicable) F.PATIENT CONSENT I acknowledge that: The doctor has explained my medical condition and proposed procedure. I understand the risks of the procedure including the risks that are specific to me, and the likely outcomes. The doctor has explained other relevant treatment options and their associated risks. The doctor has also explained the risks of not having the procedure. I have been given the Anesthesia informed consent form.
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I have been given the patient information sheet regarding the condition, procedure, risks and other associated information. I was able to ask questions and raise concerns with the doctor the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.

I understand that the procedure may include a blood/blood product transfusion. I understand that a doctor other than the consultant surgeon may conduct the procedure I understand this could be a doctor undergoing further training. I understand that if organs or tissues are removed during the surgery that these may be retained for tests for a period of time and then disposed of sensitively by the hospital. The doctor explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly. It has been explained to me, that during the course of or subsequent to the Operation/Procedure, unforeseen conditions may be revealed or encountered which may necessitate urgent surgical or other procedures in addition to or different from those contemplated. In such exigency, I further request and authorize the above named Physician / Surgeon or his designee to perform such additional surgical or other procedures as he or they consider necessary or desirable.

On the basis of the above statements, I hereby authorize Drand those he may designate as associates or assistants to perform upon me the following medical treatment, surgical operation and / or diagnostic / therapeutic procedure.. I REQUEST TO HAVE THE PROCEDURE Name of Patient/Substitute Decision Maker Relationship . SignatureDate. Name of the Witness Relationship/Designation SignatureDate
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FERENCES G.INTERPRETERS STATEMENT I have given a translation in Name of interpreter. SignatureDate H. DOCTORS STATEMENTS I have explained The patient s condition Need for treatment The procedure and the risks Relevant treatment options and their risks Likely consequences if those risks occur The significant risks and problems specific to this patient I have given the Patient/ Guardian an opportunity to: Ask questions about any of the above matters Raise any other concerns, which I have answered as fully as possible. I am of the opinion that the Patient/ Substitute Decision Maker understood the above information. Name of doctor.. Designation SignatureDate..

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MSSH/Physician/Consent Craniotomy/Ver.1/Oct.2007

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