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Brain and spinal tumours

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Potential side effects of surgery for brain and spinal cord cancer

Side effects can occur with any type of treatment for brain and spinal cord cancer, but not everyone has them or experiences them in the same way. Side effects of surgery will depend mainly on:

  • the type of surgery
  • the location of the tumour
  • whether or not the tumour was completely removed
  • damage to normal brain or spinal cord tissue during surgery
  • the person’s neurological status before surgery
  • the person’s overall health

Side effects can happen any time during, immediately after, or a few days or weeks after surgery. Most side effects go away after surgery. Late side effects can occur months or years after surgery. Some side effects may last a long time or be permanent.

Side effects following surgery for brain and spinal cord cancer are rare, but they can happen. It is important to report side effects to the healthcare team.

Bleeding

Bleeding (hemorrhage) can occur during surgery or may occur after surgery has finished if a blood vessel leaks. Nursing staff frequently check bandages and drains to look for bleeding right after surgery. Sometimes the only evidence of post-operative bleeding in the tumour site may be a sudden neurological change. If bleeding occurs and is severe enough, the surgeon may have to take the person back to the operating room to find where bleeding is coming from and to stop it.

A small amount of bloody drainage may be expected after surgery. Report large amounts to the doctor or the healthcare team.

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Pain

Pain often occurs due to trauma to the tissue during surgery. Pain-relieving medications are used to control pain. It may take time for pain to go away after surgery, depending on the type of procedure, how the person heals and how well the person tolerates pain. Check with the doctor if pain doesn’t go away or pain medications do not relieve the pain.

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Swelling around the incision

Some swelling along and around the incision can happen as part of the body’s normal healing process. The swelling is usually the greatest 2–4 days after surgery. The amount of swelling varies and will go away on its own.

This normal swelling may cause symptoms, including pain, to get worse. As the area heals, the swelling goes down and the symptoms usually improve.

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Infection

Some people develop a wound infection after surgery. This is not a common side effect, but it can occur after any type of surgery. Sometimes tubes are placed into the wound to drain extra fluid. Antibiotics may be used to help prevent or treat an infection. Wound infections are a temporary side effect of surgery.

Tell the doctor or healthcare about signs of infection, such as redness, pus or foul-smelling drainage, increased swelling or tenderness of the incision site and increased temperature (fever).

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Cerebral edema

Cerebral edema is swelling of brain tissue. It is caused by the manipulation of brain tissue surrounding the tumour during surgery, changes in blood flow or brain injury. The amount of swelling varies in each person and usually reaches its peak 48–72 hours after surgery.

Medicines called corticosteroidscorticosteroidsAny steroid hormone that acts as an anti-inflammatory by reducing swelling and lowering the body’s immune response (the immune system’s reaction to the presence of foreign substances)., such as dexamethasone (Decadron, Dexasone), are usually given for several days after surgery to help lower the risk for cerebral edema. Other measures, including elevating the head of the bed and draining CSF, may be done to control intracranial pressure.

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Loss of neurological function

Both tumours and surgery have an effect on normal brain and spinal tissues and their function. Neurological problems that existed before may be worse just after surgery, or new problems may develop after surgery. New problems are usually related to changes in blood flow or manipulation of the brain or spinal cord during surgery. The person with major or long-standing neurological problems before surgery may show no improvement or worsening after surgery. If a new neurological problem develops after surgery, normal neurological function may not return.

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Seizures

Seizures can occur following brain surgery because surgery may interrupt or cause abnormal electrical signals within the brain. Some people have an aura, which is an unusual feeling that warns them that they are about to have a seizure. Some seizures can be mild, while others cause more serious symptoms. Symptoms of seizures include:

  • unusual smells or tastes
  • visual changes or hallucinations
  • twitching or jerking of the muscles or limbs
  • biting the tongue
  • drooling
  • loss of bladder control
  • loss of consciousness (complete or momentary)
  • confusion

Anticonvulsants (anti-seizure medicines) are given to manage seizures. The healthcare team will do regular blood tests to check the level of the anticonvulsant drug in the blood. If the levels are too low, there may not be enough drug in the body to effectively control seizures. Some anticonvulsants used to prevent and treat seizures include:

  • phenytoin (Dilantin)
  • phenobarbitol
  • carbamazepine (Tegretol)
  • valproic acid (Depakene, Epival)

For more detailed information on specific drugs, go to sources of drug information.

Seizures may become a long-term problem and the person may have to take the anti-seizure medication for months or years after surgery.

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Blood clots

A blood clot in the legs is called a deep vein thrombosis (DVT). A DVT can occur right after surgery or some time later because of decreased mobility and other factors. In the most serious circumstances, a blood clot can break off and travel to the lungs (called a pulmonary embolus or PE), causing shortness of breath and low oxygen levels.

Stopping smoking before surgery helps reduce the risk of blood clots. Frequent position changes, leg and ankle exercises and early mobility also help reduce blood clots. Low doses of a blood thinner, such as heparin, may be given to help reduce the risk of blood clots.

In rare cases, blood clots (hematomas) can occur in the brain or between the dura mater and the surface of the brain (subdural hematoma) after surgery. These clots are usually small and can be absorbed by the body over a number of months. Surgery may be needed if the clot is large and puts pressure on the brain.

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Hydrocephalus

Hydrocephalus is a buildup of cerebral spinal fluid (CSF) in the ventricles of the brain. This is caused by a blockage in the flow of CSF between the ventricles. The blockage may be temporary or permanent. An external ventricular drain (EVD), shunt or endoscopic third ventriculostomy (ETV) may be needed to help drain the extra fluid.

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Leakage of cerebrospinal fluid

Surgery for a brain tumour or spinal cord tumour often changes the normal flow of cerebral spinal fluid (CSF) in and around the brain and spinal cord. CSF may leak out through the incision after surgery. If the leakage continues, surgery may be needed to repair the site of the leak.

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Separation of the wound

The edges of a wound are usually held in place with stitches or staples until the incision heals enough to remove them. The edges of the wound may separate after surgery (called wound dehiscence). Minor separation of the skin edges may not be a serious problem. Separation of underlying muscle or fat edges can be more serious and might result in the protrusion of an organ or tissue (hernia). Strenuous physical activity is usually avoided for 6–8 weeks after surgery to help prevent dehiscence.

Report gaping of the incision, an incision that doesn’t heal or a feeling that the incision has “given way” to the doctor or the healthcare team.

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