Life After Brain Surgery: Memory, Sleep, Vision and Fatigue Months Later

A craniotomy usually means 3 to 7 days in the hospital, and the bone can take 6 to 12 months to fully heal.^1,2 Studies of people after meningioma surgery find thinking problems that last at least a year, and fatigue years later, in a meaningful share of patients.^5,7 Here is what recovery usually looks like, which problems tend to linger, and what helps when they do.

How long does it take to recover from brain surgery?

A craniotomy is surgery where a surgeon removes a piece of the skull, called a bone flap, to reach the brain, then usually puts it back with small titanium plates.¹ Most people go home 3 to 7 days later.¹

After that, recovery happens in overlapping stages:

• The first weeks: wound healing, tiredness, and limits on activity. MedlinePlus advises not lifting more than 20 pounds for the first two months.²
• The first months: energy slowly returns, though MedlinePlus notes that low energy "may last for several months."² Your surgeon decides when you can drive.
• The first year: complete healing of the bone may take 6 to 12 months.² In one meningioma study, average thinking scores improved over the first year, though most individuals stayed about the same.⁵

Going back to work can take longer than people expect. In a Swedish study of 956 working-age people who had surgery for a meningioma, 57% were working two years after surgery, compared with 84% of similar people who had not had surgery.³

What are the long-term side effects of a craniotomy?

MedlinePlus lists problems with speech, memory, muscle weakness, balance and vision as possible after brain surgery, and notes that "these problems may last a short while or they may not go away."¹ Which ones you notice depends on where the surgery was and why it was done. The most common lingering complaints are covered below.

Memory and thinking

Thinking changes often come from the condition that needed surgery as well as from the surgery itself. In a study of people with a meningioma, 69% scored low in at least one thinking area before surgery and 44% did three months after.⁴ A larger study that followed meningioma patients for a year found that group scores improved but stayed below normal levels at 12 months.⁵

Fatigue

After meningioma surgery, fatigue can last for years. In a study of 275 people about five years after a meningioma diagnosis, most of whom had surgery, 26% were classified as fatigued.⁷ For some people, mental fatigue means needing to rest after a conversation, a meeting or a grocery trip.

Headaches

In a study of 79 people who had surgery for a brain aneurysm, 40% developed post-craniotomy headache within six months.⁶

Sleep

A 2023 review of 34 studies found that sleep problems are "highly prevalent" in people treated for brain tumors and are linked to surgery, radiation and steroid medicines.⁸ Poor sleep makes fatigue, memory and mood worse, so it is worth raising with your doctor.

Vision

Vision changes, such as blind spots or double vision, depend heavily on where in the brain the surgery was. After temporal lobe surgery for epilepsy, for example, most patients have some loss of their visual field.⁹ If your vision changed after surgery, ask your surgeon or an eye specialist to test your visual field.

Mood

Depression is common in people with brain tumors: a review of 37 studies found it in about 1 in 5.¹⁰ Tell your doctor if your mood has changed.

When should you get help after brain surgery?

What helps when problems last for months?

Start with your own care team. Ask about sleep, mood, medicines and hormones, because some causes of fatigue and brain fog are treatable directly.

Rehabilitation is the next step when thinking, energy or mood problems remain. In a randomized trial of 140 people with gliomas (a type of brain tumor) who had memory and attention complaints, a cognitive rehabilitation program improved attention and verbal memory scores and reduced mental fatigue six months later.¹¹ Practice standards for cognitive rehabilitation after traumatic brain injury and stroke support attention training, strategies for mild memory problems, and comprehensive programs.¹² These studies tested other programs. Cognitive FX has not published outcomes for people after brain surgery.

At Cognitive FX, treatment starts with an fNCI scan, a functional MRI that measures how 56 brain regions work while you do thinking tasks. Your therapy week is planned from the results: cognitive therapy, cardiovascular work, vestibular and vision therapy, neuromuscular therapy and counseling, in one building, with rest built in. A second scan at the end of the week is compared with the first. One week is $13,000, scans included, and we accept CareCredit, HSA and FSA. We are out-of-network and give you the paperwork to submit to your insurance.

We see people only after their surgeon has cleared for intensive physical and mental exercise, including cardiovascular exercise, and not during active cancer treatment unless their oncologist agrees. Our program does not replace follow-up with your neurosurgery or oncology team.

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  Dr. Alina K. Fong, PhDClinical Director

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  Dr. Lynn M. Gaufin, MDDirector of Neurosurgery

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  Annie Morgan, RNDirector of Patient Care

Plus other therapists as needed. Meet the full team

Related reading: sleep problems after a brain injury and memory loss after a head injury.

Frequently asked questions about recovery after brain surgery

How long does it take to recover from brain surgery?

Most people stay in the hospital for 3 to 7 days after a craniotomy. The bone can take 6 to 12 months to heal completely, and low energy can last for several months. How quickly people feel like themselves again varies widely and depends on the type of surgery, where in the brain it was, and why it was done.

What are the long-term side effects of a craniotomy?

Depending on the surgery, people can have lasting problems with memory, attention, speech, balance, vision, headaches, fatigue, sleep or mood. Some improve over the first year, and MedlinePlus notes that some may not go away.

Is it normal to be this tired months after brain surgery?

It is common. In a study of 275 people around five years after a meningioma diagnosis, most of whom had surgery, 26% were classified as fatigued. Tell your doctor about fatigue that is not improving, because some causes, such as sleep problems, low mood or medication side effects, can be treated.

Can brain surgery cause memory loss?

It can, and so can the condition that led to the surgery. In a study of meningioma patients, 69% scored low in at least one thinking area before surgery and 44% did three months after. In a larger study, scores improved over the first year but, as a group, stayed below normal.

Can I get help for memory or fatigue problems a year after brain surgery?

Rehabilitation that targets attention, memory and fatigue helped people with brain tumors in a clinical trial. If problems still limit your daily life and your surgeon agrees, a free consult can tell you whether our program fits. We see people only after their doctors have cleared for intensive physical and mental exercise, including cardiovascular exercise.

When should I call a doctor after brain surgery?

Call 911 for a seizure, chest pain or trouble breathing, being hard to wake, or sudden weakness, numbness, face drooping or trouble speaking. Call your surgeon the same day for a fever of 101°F or higher, a wound that is red, draining or opening, fluid or blood dripping into your throat, a headache your medicine does not help, vision changes, or more sleepiness or confusion than usual.

Sources

1. MedlinePlus. Brain surgery. medlineplus.gov
2. MedlinePlus. Brain surgery: discharge. medlineplus.gov
3. Thurin E, et al. Return to work following meningioma surgery: a Swedish nationwide registry-based matched cohort study. Neuro-oncology practice, 2020. PubMed
4. Meskal I, et al. Cognitive improvement in meningioma patients after surgery: clinical relevance of computerized testing. Journal of neuro-oncology, 2015. PubMed
5. Rijnen SJM, et al. Cognitive outcomes in meningioma patients undergoing surgery: individual changes over time and predictors of late cognitive functioning. Neuro-oncology, 2019. PubMed
6. Rocha-Filho PA, et al. Post-craniotomy headache: characteristics, behaviour and effect on quality of life in patients operated for treatment of supratentorial intracranial aneurysms. Cephalalgia, 2008. PubMed
7. Quach KT, et al. The prevalence and severity of fatigue in meningioma patients and its association with patient-, tumor- and treatment-related factors. Neuro-oncology advances, 2023. PubMed
8. Martin JA, et al. Prevalence and management of sleep disturbance in adults with primary brain tumours and their caregivers: a systematic review. Journal of neuro-oncology, 2023. PubMed
9. Piper RJ, et al. Application of diffusion tensor imaging and tractography of the optic radiation in anterior temporal lobe resection for epilepsy: a systematic review. Clinical neurology and neurosurgery, 2014. PubMed
10. Huang J, et al. Association between depression and brain tumor: a systematic review and meta-analysis. Oncotarget, 2017. PubMed
11. Gehring K, et al. Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. Journal of clinical oncology, 2009. PubMed
12. Cicerone KD, et al. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Archives of physical medicine and rehabilitation, 2019. PubMed