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
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
Step 4: Find the Problem
- using retractors
- using operating microscope/loupe
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
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).
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.
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
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
How to prevent it: anti-seizure medication
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