Cranial Surgery - Post-op Instructions

Wound care

• Keep incision dry for the first 72 hours after surgery
• We encourage keeping long hair off the incision with hair ties or clips
• Always wash hands thoroughly before touching your incision
• Gently wash the hair and skin near the incision daily with baby shampoo starting on the 3rd day after surgery
• Pat hair dry or use a hair dryer on a cool setting. Avoid rubbing the incision
• Clean the incision each morning and night with either 2% CHG (chlorhexidine) wipes or a CLEAN washcloth, warm water, and mild soap
• For the first 7 days after surgery, apply antibiotic ointment such as Neosporin to the incision each morning and night after cleaning the incision
• Do not allow scabs to form on the incision as they can harbor bacteria. Scabs may be removed with warm water or hydrogen peroxide. Any bleeding after scab removal should stop with gentle pressure.
• You may wear hats or other loose coverings when not home if you wish. Ensure the wound does not get sweaty.
• Outside of necessary wound care, avoid touching, rubbing, or patting your incision.
• Staples/sutures will generally be removed 2 weeks after surgery. Call the office if you do not have an appointment arranged
• If you experience any drainage or increasing redness/tenderness to the incision, call the office right away.

Activity

• If physically able, 30-60 minutes of walking should be done daily, but not all at once. Divide your walks into intervals of 10-15 minute walks at a time. Have someone accompany you for the first few times until you feel comfortable.
• Activities such as lifting >10 lbs, exercise, or excessive activity are restricted during the first 6 weeks
• Straining can raise intracranial pressure, which is the pressure inside of your head. 
• This means NO household chores such as laundry, physical hobbies such as golfing, hunting/shooting, or yard work.
• If you have young children or grandchildren, do NOT pick them up. 
• Do NOT allow pets in the bed with you or near the incision. Wash hands thoroughly after petting/caring for any animals
• We generally recommend sleeping slightly propped up to help with any swelling
• You may drive as long as you are not taking narcotic pain medication.
• Patients who have had seizures within the past 6 months cannot drive.
• It is ok to ride as a passenger if you are taking narcotic pain medication.
• Return to work will depend on the type of surgery and what work you did prior to surgery. Do not return to work until cleared by the office

Tobacco

• Avoid smoking/vaping as this restricts the blood flow of oxygen and nutrients to the wound, leading to delayed wound healing and increased risk of infection after surgery
• Carefully consider quitting smoking during this time. If you need help quitting smoking, contact your primary care physician.

Medications

• If prescribed, AEDs (Keppra, Dilantin, etc)  are generally taken to prevent seizures for the first 7 days after surgery. If you have had a seizure, you will need to stay on seizure medication until instructed to stop by a neurologist.
• Completely finish any steroid regimens, if prescribed. Be sure to take an acid blocker (Pepcid, Preavid, Tums, etc.) while on steroids to prevent heartburn. Take with food.
• Avoid blood thinners (Aspirin, Plavix, Coumadin, Eliquis, etc.) until cleared by the office (typically allowed to restart on 5th day after surgery)
• Take pain medication only as directed. You should begin to wean the amount and frequency of pain medications you take every couple of days or so
• Ice packs may be applied to incision as needed for swelling
• Take pain medication with food to minimize any associated nausea
• Avoid NSAIDs (Ibuprofen, Aleve) and aspirin, BC powder, or other aspirin containing products for pain during the first month after surgery
• Be sure to take a gentle over the counter laxative (Colace, etc) while taking pain medication to prevent constipation. Walking will also help with this.
• Take a general multivitamin daily for at least the first month after surgery
• For any refill requests, call the office in advance only during regular office hours. Please allow at least one business day for medication refills.
• If taking a GLP-agonist such as Ozempic, Mounjaro, Zepbound, Wegovy etc., you no longer have to skip doses before surgery, but you MUST start a full liquid diet for the day prior to surgery. If you do not comply, there is a possibility your surgery will be cancelled. It is recommended to still delay restarting these medications until 5-7 days after surgery.

Diet

• Continue your regular diet from before surgery unless directed by office. Avoid alcohol
• Ensure adequate protein intake. BOOST and Ensure drinks are simple solutions to ensure adequate protein intake, if needed.
• If diabetic, continue strict diabetic diet adherence to promote healthy wound healing
• For any postoperative nausea. You may follow a “BRAT” diet (Bananas, Rice, Applesauce, Toast) if needed and advance diet as tolerated

When to call office

• Any persistent drainage from incision, or increasing redness or swelling.  Fever greater than 101.4
• New seizures, intense worsening of headache, visual changes, weakness on one side of the body. Any usual behavior or excessive sleepiness.
• Calf tenderness or swelling, chest pain, shortness of breath, burning with urination
• Constipation not alleviated by over the counter laxatives or suppositories/enemas