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Step 1: Prepping the Patient

  • intravenous (IV) line
  • general anesthesia
  • 3-pin cranial fixation device
  • draining the lumbar region
  • brain relaxation drugs

Step 3: Expose the Brain

cut and fold back dura

different positions of the 3 pin cranial fixation device

The dura being folded back

Step 2: The Incision

  • cleanse the scalp
  • incision is done behind hairline
  • opening skull flap
  • skin/muscles pulled back
  • burr hole(s) drilled into skull
  • remove skull flap
  • flap stored in freezer

removal of the bone flap

Step 4: Find the Problem

  • using retractors
  • using operating microscope/loupe

loupe

operating microscope

Causes

Craniectomy Surgery in Regard to Patient Care

Brain Tumour

Hematoma

Step 5 & 6: Fix the Problem and Close the Dura

  • unusual growth of cells
  • deemed malignant or benign

Figure 2. An epidural, subdural and intracranial hematoma

  • when an artery, blood vessel, or vein is damaged
  • blood cells collect outside of the blood vessel
  • can cause swelling and bleeding in the brain --> requires a craniectomy
  • using special surgical tools
  • long handled scissors, lasers, drills, ultrasonic aspirators
  • jet spray of water and suction
  • use of evoked potential monitoring

  • closing the dura and suturing
  • second surgery replaces

the bone flap

an ultrasonic aspirator

healthy brain vs one with brain tumour

Aneurysm

Skull Fracture

Arteriovenous Malformation (AVM)

  • Perforation by broken bone --> blood vessels burst
  • occurs when a blood vessel is damaged or a vessel’s wall becomes weakened.
  • blood vessel bulges outwards.
  • If bulge bursts, severe complications can occur (including immediate death)
  • blood vessels become tangled
  • higher rate of bleeding
  • craniectomy eliminates this risk

Two different types of aneurysms in the cerebral area: a saccular and fusiform aneurysm

As seen, the entanglement of vessels are comprised of arteries (red) and veins (blue).

fracture in the skull

Infection

Invasion of unknown object

herpes virus - most common cause of emphalitis

  • Eg. meningitis, encephalitis, toxoplasmosis, and subdural empyema.
  • if swelling occurs, craniectomy is performed
  • Invasion of a foreign object (such as a bullet) --> bleeding in the brain--> potentially dangerous clotting.

  • clotting in the cerebral area --> lack of oxygen to the brain --> stroke.

bullet invading the head

normal meninges tissue vs infected one

Intense Pain

Serena Aseerwatham

Solutions:

  • nerve scalp blocks
  • scalp infiltrations
  • Morphine
  • narcotic medication (2-4 weeks only)

The Procedure

A Patients Perspective

Infection

Changes to the Skull Flap

  • Solution: artificial plate
  • flap may be infected
  • may not fit patients head after time has passed

Risks and Complications

healthy brain vs brain with meningitis

  • skull is open for 3-5 hours
  • meningitis

artificial skull flap in patient's skull

  • Changes to the skull flap
  • Seizures
  • Disabilities
  • Infection
  • Intense pain

Post-Op Life

Craniotomy vs Craniectomy

protective helmet

bilateral decompressive craniectomy:

before and after 2nd surgery

Craniectomy

Disabilities

Seizures

  • skull flap remains off for 3 months
  • allows swelling to reduce
  • patient wears a protective helmet

In between surgeries:

  • protective helmet (1-3 months)
  • dizziness
  • skull depression

Craniotomy

  • Nerve damage
  • paralysis or weakness
  • loss of mental function
  • stroke
  • permanent brain damage
  • cerebral cortex controls consciousness
  • if it is tampered with, one may slip into unconsciousness
  • this is where seizures occur
  • skull flap is replaced
  • immediate recovery

the cerebral cortex, responsible for consciousness

with skull flap replaced

How to prevent it: anti-seizure medication

protective helmet

Thank You!

Concerns & Restrictions

  • seizing
  • swelling
  • redness
  • drainage
  • pain around incision site
  • no contact sports
  • no driving until given permission
  • nothing that causes extreme fatigue
  • avoid whirlpools, swimming pools, and bathtubs

ECG

62

bpm

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