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CRANIOTOMY

What is Craniotomy ?

 

It is a Brain Surgery which is critical to the survival of the patient. A craniotomy is removal of part of the bone from the skull to keep the brain exposed through surgical procedures. To perform this surgery, specialized tools are used to remove a section of bone known as the flap. The bone flap is removed for some time then replaced after the brain surgery.

A craniotomy is performed for the specific region of the skull where the bone is removed. In case, the craniotomy is opened in the frontal bone it is called a frontal craniotomy. If a craniotomy involves two contiguous regions of the skull, it is called front temporal craniotomy. If three regions are involved, all names are included in the description ex, a fronton temporoparietal craniotomy. Smaller craniotomies are often referred to as keyhole craniotomies and are used in situations that require less bone removal.

Types of craniotomies :
  • Craniotomy
  • Endoscopic craniotomy
  • Eyebrow craniotomy
  • Keyhole craniotomy
  • Stereotactic craniotomy
  • Translabyrinthine craniotomy

A craniotomy is any bony opening that is cut into the skull. A section or part of the skull called a bone flap is removed to access the brain underneath. There are many types of craniotomies, which are named according to the area of the skull to be removed. The bone flap is replaced. If the bone flap is not replaced the procedure is called craniotomy. Some stereotactic frames, image-guided computer systems or endoscopes are used to precisely direct instruments through these keyholes. Keyhole craniotomies are used for minimally invasive procedures.

Diagnosing procedures of craniotomy :

Some craniotomy procedures may utilize the guidance of computers and imaging to reach the precise location within the brain that is to be treated. This requires the use of frame placed onto the skull or a frameless system using superficially placed markers on the scalp. When either of the imaging procedure is used along with the craniotomy procedure, it is called stereotactic craniotomy.

Scans made of the brain, in tune with the computers and localizing frames provide a three-dimensional image, for example, of a tumour within the brain. It is useful in making the distinction between tumour tissue and healthy tissue and reaching the precise location of the abnormal tissue.

Stereotactic biopsy of the brain it is one of the procedure. In this, a small needle is guided to an abnormal area so that a piece of tissue may be removed for examination under a microscope. Stereotactic aspiration, removal of fluid from cysts of the brain.

Endoscopic craniotomy is another type of craniotomy wherein the insertion of a lighted scope with a camera into the brain through a small incision in the skull is done,

A craniotomy is the procedure that involves the permanent removal of a portion of the skull. This is done if swelling is likely after brain surgery or the skull bone flap cannot be replaced for any other reasons. Other related procedures that may be used to detect brain disorders include cerebral arteriogram, a computed tomography (CT) scan of the brain, electroencephalogram (EEG), magnetic resonance imaging (MRI) of the brain, positron emission tomography (PET) scan, and x-ray of the skull.

Reasons for craniotomy and how long does surgery take :
  • A craniotomy may be small or large depending on the problem.
  • It can be done during surgery for various neurological diseases, injuries, or conditions such as brain tumours, hematomas (blood clots), aneurysms, and skull fractures.
  • Other reasons for craniotomy may include foreign objects (bullets), swelling of the brain, or infection.
  • Draining a brain abscess- an infected pus-filled pocket.
  • Repairing a tear in the membrane lining the brain.
  • Relieving pressure within the brain by removing damaged or swollen areas of the brain that may be caused by trauma injury or stroke.

Depending on the reason for the craniotomy this surgery requires hospital stay that ranges from a few days to weeks. Open surgical procedures those that require a craniotomy usually take 4 to 6 long hours. Most people are hospitalized for 5 to 7 days after an open procedure.

 

Who performs the procedure ?

A craniotomy is performed by neurosurgeons. Some have additional training in skull base surgery. A neurosurgeon works with the team of head and neck, otologic, oculoplastic and reconstructive surgeons.

Before surgery :

Before surgery, you will undergo some tests like blood test, electrocardiogram, chest x-ray etc. You will be asked to sign a consent form that gives permission to do the surgery. Study the form carefully and ask questions if something is not clear. Your doctor will ask you about your medical history that is allergies, medicines, anesthesia reactions, previous surgeries. You may wish to donate blood several weeks before surgery. Your surgeons will ask to discontinue all non-steroidal anti-inflammatory medicines that are naproxen, Advil, etc. And blood thinners aspirin etc. One week before surgery. You may be asked for stop smoking, chewing tobacco, and drinking alcohol one week before and two weeks after surgery because these activities can cause bleeding procedures. You may be asked to wash your hair with a special antiseptic shampoo the night before the surgery. The areas around the surgical site will be shaved.

During surgery :

The procedure can take 3 to 5 hours or longer. The first step of the procedure is preparing the patient. No drink is permitted past midnight the night before surgery. Patients admitted to the hospital in the morning of the craniotomy. An intravenous (IV) line will be inserted in your arm or hand. A urinary catheter will be inserted to drain the urine. General anesthesia is given while you lie on the operating table. Once you are asleep your head is placed in a 3 pin skull fixation device, which attaches to the table and holds your head in position during the procedure. Insertion of a lumbar drain in your back helps remove cerebrospinal fluids (CSF), thus allowing the brain to relax during surgery. A brain relaxing drug called mannitol may be given.

A skin incision is made usually behind the hairline. The skin and muscle are lifted off the bone and folded back next, one or smaller burr holes are made in the skull with a drill. Inserting a special saw through the burr holes, the surgeon uses this craniotomy to cut the outline of the bone flap. The cut flap is lifted and removed to expose the protective covering of the brain called the durra. The bone flap is safely stored until it is replaced at the end of the procedure.

Neurosurgeons use a special magnification glasses, called loupes or an operation microscope to see the delicate nerves and vessels.

The problem has repaired the retractors the brain are removed and the durra is closed with sutures. The bone flap is replaced back in its original position and secured the skull with titanium plated and screws. A sterile bandage or dressing will be applied over the incision.

After surgery :

After surgery, you are taken to the recovery room where vital signs are monitored as you awake from anesthesia. The length of the hospital stay varies from only 2-3 days or 2 weeks depending on the surgery and development of any complications. When released from the hospital you will be given discharge instructions. Stitches or staples are removed 7-10 days after surgery.

Frequent neurological checks will be performed by the nursing and medical staff to test your brain function and to make sure your body systems are functioning properly after your surgery. You will be asked to follow a variety of basic commands such as moving arms and legs, to assess your brain function. Your pupils will be checked with a flashlight, and you will be asked questions to assess your orientation.

Depending on your situation you may be given liquids, to drink a few hours after surgery. Your diet may be gradually changed to include more solid foods as tolerated.

After surgery, a headache is managed with narcotic medication. A medicine anticonvulsant may be prescribed temporarily to prevent seizures. Some patients develop side effects example drowsiness, balance problems, rashes caused by these anticonvulsants. In these cases, blood samples are taken to monitor the drug levels and manage the side effects.

After surgery at home :

Once you are home it is important to keep the incision clean and dry. The physician will give specific bathing instructions. The incision may ache, especially with deep breathing, coughing and exertion. Take a pain reliever for soreness as recommended by your physician will ease the pain. Driving must be avoided after surgery until discussed with your surgeon avoid sitting for long periods of time. The following are the precautions to be taken.

  • Heavy weight lifting must be avoided.
  • No, not smoke and do not drink alcoholic beverages.
  • Drink a lot of water and take more fluids this may avoid the constipation problem after surgery.
  • Eat healthily and f fibre rich content food.
  • Walking is encouraged. Start with small walks and gradually increase the distance.
  • You may be shower and shampoo 3to 4 days after surgery unless otherwise directed by your surgeon.
Notify your physician to report any of the following :
  • Fever and or chills
  • Increased pain around the incision site
  • Redness swelling or bleeding or drainage from the incision site or face
  • Vision changes
  • Speech difficulty
  • Confusion or excessive sleepiness.
Risks of the surgery :

No surgery is without risks associated. General complications of any surgery include bleeding, blood clots, infection, and reactions to anesthesia. Specific complications related to a craniotomy may include :

  • Stroke
  • Swelling of the brain, which may require a second craniotomy
  • Loss of mental function
  • Hemorrhage (bleeding)
  • Nerve damage, which cause muscle paralysis or weakness
  • Pneumonia (infection of the lungs)
  • Permanent brain damage with associated disabilities
  • Unstable blood pressure
  • Seizures
  • Muscle weakness
  • CSF leak, which may require repair
  • Speech difficulty
  • Coma
 

Does age affect outcomes after surgery ?

Patients treated for this disease have ranged from infants through seniors. In general, younger children have recovered quickly while older patients tend to make longer. Removal of a hypothalamic hematoma at a young age increases the chances that behavioural and cognitive symptoms will improve.

Recovery :

The recovery time varies from one to four weeks depending on the underlying disease being treated and general health prognosis. Full recovery may take up to eight weeks. Walking is a good way to begin increasing activity level. Start with short frequent walks within the house and gradually try to walk outside.

 

What are the results ?

The results of your craniotomy depend on the underlying condition being treated. The results are positive thanks to our dedicated team of neuro-surgeons and the precision in treatment procedures.

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