Do I have to shave my hair for brain surgery?

She was a young nurse working at a nearby hospital with full, wavy hair cascading down to the shoulders. She had developed symptoms from hydrocephalus, fluid build within the brain, and needed an operation to divert the fluid. The procedure is called a ventriculoperitoneal (VP) shunt procedure. For many years I had shaved or clipped a part of the hair in preparation for the scalp incision that would be used to make the hole in the skull through which the straw-like catheter would be placed into the brain fluid for drainage. That was how I had been trained to do the operation and that was the overwhelmingly common practice in neurosurgery. However, this fully employed nurse was literally begging me not to shave her head. She was undergoing surgery on a Friday and was anticipating returning to work the following week. She did not want to have to answer questions about the nature of her brain surgery let alone face the humiliation of a lopsided haircut ( we usually trimmed  just the hair in the area in which we are working). She could have gotten a professional haircut postoperatively but then her entire appearance would be changed in addition  to the surgical scar being in full view. By not shaving her hair she would be able to maintain her privacy about her surgery,  since the scar would be covered by hair, and she would retain her hair which was an important part of how she presented herself to the world.
I empathized with her but it went against the grain of  neurosurgical tradition. The conventional wisdom has been that removing the hair is necessary to help prevent infections. Infections can be particularly problematic when we place implants such as I had planned to do to treat the nurse’s hydrocephalus. I pondered the issue and checked the medical literature for precedents. I found that Ken Winston, a neurosurgeon in Denver had published his experience demonstrating that not removing the hair did not increase the risk of infection. Bolstered by his report and the experience of one of my pediatric neurosurgeon colleagues, who had been doing  shaveless  VP shunt implantations without increased infection rate, I performed the operation without removing the hair. Needless to say, she was elated and very grateful. She returned to work in about two days and did not miss a beat. Unless she told them, her friends and colleagues had no inkling that she had undergone the operation.
That situation occurred about 15 years ago. Having broken through the mental barrier, I went on to routinely perform brain surgery without removing the hair. My patients, especially the female ones, have been very grateful. To some it may seem trivial relative to the gravity of an operation  to repair a ruptured brain aneurysm or to remove a brain tumor.  However, to many it is a big deal for the hair is an important part of our appearance. To have it even partially removed affects  how one thinks he or she is viewed. Thus, one’s sense of integrity can be altered by lopping off a part of the hair, adding further to the stress of  undergoing surgical intervention.

Before adapting the routine of not removing hair for brain surgery, I had numerous occasions in which after doing a successful brain operation the patient would ask “But why did you have to cut off my hair?” Even now people sheepishly say during preoperative counseling , “ I know it is not that important but how much of my hair are you going to shave?”  There is uniformly an audible sigh of relief and relaxation of brow furrowing  when I explain that no hair will be removed. The response then is usually one of disbelief, “Really? Are you serious?”

A recent article in the Journal of Neurosurgery  reviewed the medical literature regarding the evidence for the practice of shaving hair in neurosurgery. The authors found that the literature indicates that shaving the hair does not reduce the infection rate in neurosurgery. To the contrary, some papers suggest that shaving may even increase the risk for infection. The authors also point out that not removing the hair may add some extra time and cost to the procedure because of the need to adequately disinfect the hair and the need to work around it. Beyond neurosurgery systematic review of medical evidence indicates that shaving does not reduce the risk of infection in other types of surgery.

Admittedly, not shaving or clipping the hair takes an extra effort by the neurosurgeon. Extra time is needed to part the hair, prepare the site with disinfectant and allow the disinfectant to dry. It may also take extra time to work around the hair to place the skin  stitches for incision closure. Nonetheless, it is well worth the patient satisfaction that it fosters.

References:

1)   Broekman ML et al: Neurosurgery and shaving: what’s the evidence? A review;  J Neurosurg.  2011 Jul 1  {pubonline        ahead of print}

2)   Tanner et al: Preoperative hair removal to reduce surgical site infection; Cochrane Database Syst Rev.  2006 Apr 19;           :CD004122.
3)   Winston KR: Neurosurgery and hair. Neurosurgery 31: 320-329, 1992.
About these ads

About ejbernardmd

Neurosurgeon affiliated with Anchorage Neurosurgical Associates, Inc. in Anchorage, Alaska.
This entry was posted in Brain, Brain surgery, health and tagged , , . Bookmark the permalink.

One Response to Do I have to shave my hair for brain surgery?

  1. Saffy says:

    Brilliant. Thank you.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s