Craniotomy is a surgery that makes an opening in the skull. A portion of the skull, called a bone flap, is removed to gain access to the brain underneath. Depending on the problem, the craniotomy may be small or large. It may be used to treat brain tumors , hematomas (blood clots), aneurysms , traumatic head injuries , foreign bodies, brain swelling, or infection. The bone flap is usually replaced with small plates and screws at the end of the surgery.
What is craniotomy?
Craniotomy procedures are named according to the area of skull to be removed (Figure 1). After the surgeon repairs the problem, the bone flap is then replaced or covered with plates and screws. If the bone flap is not replaced, the procedure is called a craniectomy.
Craniotomies vary in size and complexity. A dime-sized craniotomy is called a burr hole; a "keyhole" craniotomy is a quarter or larger. Stereotaxic frames, image-guided computer systems, or endoscopes can be used to precisely place instruments in these small holes. Drilling holes and keyholes for minimally invasive surgery :
- inserting a shunt into the ventricle to drain cerebrospinal fluid (to treat hydrocephalus)
- inserting deep brain stimulator (DBS)
- inserting an intracranial pressure (ICP) monitor
- Removing a sample of tissue cells (needle aspiration)
- Draining a blood clot (hematoma aspiration)
- Inserting an endoscope to remove the tumor
- Microvascular decompression
A complex skull base craniotomy involves removing the bone that supports the base of the brain, which The delicate cranial nerves , arteries and veins leave the skull. Reconstructing the skull base may require additional expertise from a head and neck, otology, or plastic surgeon. Surgeons often use image guidance systems to plan access to hard-to-reach lesions:
- Removing deep brain tumors or AVMs; clipping aneurysms
- Removing tumors that have invaded the bone
While most skull openings are as small as possible, large decompressive craniectomy Surgery can cause brain swelling after head trauma or stroke. The bone flap is frozen and replaced several months later after recovery (cranioplasty).
Perform awake craniotomy surgery when the lesion is close to critical language areas. The bone opens while the patient sleeps and is then awakened to help the surgeon map the danger zone. The probe is placed on the surface of the brain while the patient reads or talks. This process, called brain mapping, identifies a patient's unique speech brain regions and helps surgeons avoid and preserve those functions.
There are many types of craniotomy. For details, please consult your attending physician to describe the location of the skin incision and the amount of bone removal.
Who executes the program?
Craniotomy surgery is performed by neurosurgeons; some have additional training in skull base surgery. Neurosurgeons may work with head and neck, otology, ocular oncology and reconstructive surgeons. Especially if the patient's condition is complex.
What happens before surgery?
In the doctor's office, you will review the procedure with the neurosurgeon and have time to ask questions. Sign a consent form and complete paperwork to inform the surgeon of your medical history (e.g., allergies, medications, reactions to anesthesia, previous surgeries). A few days before surgery, you will have appropriate tests (such as an electrocardiogram, chest X-ray, and blood tests) to ensure you are receiving surgical treatment.
It is important that you stop using all nonsteroidal anti-inflammatory drugs (Naproxen, Advil, etc.) and blood thinners (Coumadin, Heparin, Aspirin, Plavix, etc.) usually at least 1 week before surgery. Also, avoid smoking, chewing tobacco, and drinking alcohol 1 week before and 2 weeks after surgery, as these activities can cause bleeding problems.
If image-guided surgery is planned, an MRI will be scheduled before surgery. reference points (small markers) can be placed on the forehead and behind the ears. Markers help align the preoperative MRI with the image guidance system. The fiducial points must remain in place and cannot be moved or removed prior to surgery to ensure scan accuracy.
Do not eat or drink after midnight the night before surgery.
Use antibacterial soap in the shower the morning of surgery
- . Wear freshly laundered, loose-fitting clothing.
- Wear flat shoes with a closed back.
- If you are instructed to take your regular medications the morning of your surgery, rinse your mouth with a small amount of water.
- Removes makeup, hair pins, contacts, body piercings, nail polish and more.
- Leave all valuables and jewelry at home.
- Bring a list of medications, including dosages and times you usually take them.
- List of allergies to drugs or foods.
The patient was admitted to the hospital the morning of the surgery. The nurse will explain the preoperative procedure and discuss any questions you may have. The anesthetist will talk to you and explain the effects of anesthesia and its risks.
What happens during surgery?
The surgery may take 3 to 5 hours or longer depending on the underlying problem being treated.
Step 1: Preparing the Patient
You will lie on the operating table and will be given general anesthesia. Once you are asleep, your head is placed in a 3-pin cranial immobilization device, which is attached to the table and keeps the head absolutely still during the procedure (Figure 2).
Figure 2. The patient's head is placed in a three-pin skull clamp, which holds the head absolutely in place during delicate brain surgery. Along the skin incision line (virtual
If using image guidance, your head will be registered in the infrared camera to correlate the "real patient" with the 3D computer model created from the MRI scan. The system acts as a GPS to help The craniotomy is planned and the lesion is located. The instrument is detected by the camera and displayed on the computer model.
Step 2: Make the skin incision
The incision area of the scalp is usually made behind the hairline. , where only an area 2.5 cm wide along the proposed incision is shaved. Sometimes the entire incision area may be shaved.
Step 3: A craniotomy is performed to open the skull
and lift the skin and muscles away from the bone. Back fold. Next, a drill is used to make small holes in the skull to allow access to a special saw called a craniotomy, where the surgeon cuts the outline of the bone window (Figure 3). The bone flap is lifted and removed to expose the protective covering of the brain called the dura mater The bone flap is safely set aside and replaced at the end of the surgery
Figure 3. A special saw called a craniotomy is used. Cut the craniotomy. The bone flap is removed to reveal the protective covering of the brain, called the dura mater. The corridor between the skull. The neurosurgeon uses magnifying glasses called loupes or a surgical microscope to view the delicate nerves and blood vessels.
Figure 4. Open the dura mater and fold it back to expose the brain.
Step 5: Correct the problem.
Sealed inside the bone, the brain cannot be easily moved aside to access and repair the problem. Neurosurgeons use a variety of very small instruments to work deep inside the brain. These include long-handled scissors, dissectors and drills, lasers, and ultrasonic aspirators. A small jet of water is used to break up the tumor and aspirate the debris). In some cases, evoked potential monitoring is used to stimulate specific cranial nerves while monitoring responses in the brain. This is done to preserve nerve function during surgery. 6: Closing the Craniotomy
After removing or repairing the problem, remove any retractors and close the dura mater with sutures. Place the bone flap back into place and secure it to the skull with small plates and screws (Figure 5). Small plates and screws remain in place to support the area, and sometimes they can be felt under your skin. Drains may be placed under the skin for several days to remove blood or fluid from the area. The skin is sewn together. Place a soft sterile cotton pad dressing over the incision.
Figure 5. The bone flap is replaced and fixed to the skull with small plates and screws.
What will happen after surgery?
After surgery, when the patient wakes up from anesthesia, the patient will be taken to the recovery room where vital signs are monitored. The breathing tube (ventilator) usually remains in place until the patient has fully recovered from anesthesia.Next, the patient will be transferred to the Neuroscience Intensive Care Unit for close monitoring.
Patients are often asked to move your arms, fingers, toes, and legs. The nurse will use a flashlight to check your pupils and then ask questions such as "What's your name?"
Nausea and headache may occur after surgery. Medications can control these symptoms. Depending on the type of brain surgery, steroid medications (to control brain swelling) and anticonvulsant medications (to prevent seizures) may be given.
Hospital stay varies from 2-3 days or 2 weeks depending on the surgery and any complications.
Discharge Instructions
Uncomfortable
- After surgery, pain can be treated with anesthetic drugs. Because narcotics are addictive, they are used for a limited period of two to four weeks. Regular use may also cause constipation, so drink plenty of water and eat high-fiber foods.
- Ask your healthcare provider before taking nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve). NSAIDs may cause bleeding and interfere with bone healing.
- A drug can be prescribed to prevent epileptic seizures. Common anticonvulsants include Dilantin (phenytoin), Tegretol (carbamazepine), and Neurontin (gabapentin). Some patients experience side effects from anticonvulsants (e.g., drowsiness, balance problems, rash). In these cases, blood samples are taken to monitor drug levels and manage side effects.
Restrictions
- Do not drive after surgery until you have discussed it with your surgeon and avoid sitting for long periods of time.
- Do not lift anything weighing more than 5 pounds (for example, 2 liters of water), including children.
- Housework and yard work will not be allowed until the first follow-up office visit. This includes gardening, mowing, vacuuming, ironing and loading/unloading the dishwasher, washing machine or dryer.
- Don't drink alcoholic beverages.
Activity
- Fatigue is common after surgery. Gradually resume normal activities.
- can suggest gentle stretching of the neck.
- Walking is encouraged; start with short distances and gradually increase the distance. Wait for other forms of exercise before discussing it with your surgeon.
Bath/Incision Care
- You can shower to keep your incision or sutures moist. Use a mild baby shampoo without harsh fragrances. Be careful not to let the water hit your incision directly. Gently clean any old dried blood from the incision area.
- Don't dip your head in the bathtub
- Check your incision daily for signs of infection, such as swelling, redness, yellow or green discharge, and warmth to the touch. Minimal swelling around the incision is expected.
When to seek medical attention immediately
If you experience any of the following conditions:
- The temperature exceeds 38.6°C
- The incision shows signs of infection, such as redness, swelling, pain, or drainage.
- If you are taking anticonvulsants and notice drowsiness, balance problems, or rash.
- Decreased alertness, increased drowsiness, weakness in the arms or legs, increased headaches, vomiting, or severe neck pain, preventing the jaw from dropping toward the chest.
Recovery
You will have a follow-up appointment 10 to 14 days after surgery. Recovery time ranges from 1 week to 4 weeks, depending on the underlying condition being treated and your general health. Full recovery may take up to 8 weeks. Walking is a great way to start increasing your activity level. Do not overextend yourself, especially if you continue to receive radiation or chemotherapy treatments. Ask your primary care physician when you can return to work. What are the risks of
?
There is no surgery and no risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Specific complications associated with craniotomy surgery may include stroke, seizures, brain swelling, nerve damage, cerebrospinal fluid leaks, and loss of some mental functions. What is the result of
?
The results of craniotomy surgery depend on the underlying condition being treated.
Normally, the skull protects the brain from damage through its rigidity; the skull is one of the least deformable structures found in nature, requiring approximately 1 ton of force to reduce the diameter of the skull by 1 centimeter. Accidental skull defects should be repaired promptly
I hope my introduction will be helpful to you.
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