14820811-Craniotomy-surgical-case-report

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Introduction: In the past, the earliest evidence of craniotomy is most likely found in the procedure called trephination, which is basically an antiquated medical intervention in which a hole is drilled or scraped into the human skull, exposing the dura mater in order to treat health problems concerning intracranial diseases. Cave painitings also indicate that people believed such practice would cure epileptic seizures, migraines, and mental disorders. It was also suggested that it was a primitive, if not the oldest, emergency surgery for head wounds. In modern medicine, it is a treatment used for epidural and subdural hematomas, and for surgical access for certain other neurosurgical procedures, such as intracranial pressure monitoring. Modern surgeons generally use the term craniotomy for this procedure. The removed piece of skull is typically replaced as soon as possible. If the bone is not replaced, then the procedure is considered a craniectomy. Today, as contemporary era comes in, it has evolved to craniotomy per se, or considering the words etymology, the surgical cutting of the cranium. A craniotomy is a surgical operation in which part of the skull, called a bone flap, is removed in order to access the brain. Craniotomies are often a critical operation performed on patients suffering from brain lesions or traumatic brain injury (TBI), and can also allow doctors to surgically implant deep brain stimulators for the treatment of Parkinson's disease, epilepsy and cerebellar tremor. The procedure is also widely used in neuroscience for extracellular recording, brain imaging, and for neurological manipulations such as electrical stimulation and chemical titration. Because craniotomy is a procedure that is utilized for several conditions and diseases, statistical information for the procedure itself is not available. However, because craniotomy is most commonly performed to remove a brain tumor, statistics concerning this condition are given. Approximately 90% of

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primary brain cancers occur in adults, more commonly in males between 55 and 65 years of age. Tumors in children peak between the ages of three and 12. Brain tumors are presently the most common cancer in children (four out of 100,000). In a news article dated April 21, 2009, it was found out that a new type of brain surgery actually allows patients to stay conscious so there will be foolproof monitoring of speech and motor functions as doctors basically fiddle with a tumor or two resting on principal tasks of their brain. Another innovation to brain surgery published on an earlier date, April 8, 2009, tells us about a new approach to brain surgery leaving no mark behind. Such feat of using the eyes as a gateway to the brain makes surgery less invasive, ergo, less risky. This procedure is called eyelid craniotomy, where in an incision will be made on the eyelid crease and there will be removal of a small bone from the patients eye socket. A smaller incision is almost always correlated to shorter hospital stay, faster recovery, and less pain. However, it is not for every patient as it is only used for those with needing brain surgery toward the front of the skull. Implications of the above information is almost always suggestive that as productive members of the society, nurses, or aspiring nurses to be more specific, as the researchers are, should generally be equipped with pertinent information and knowledge regarding such high-end surgical intervention to relieve effects of tumors, bleeding aneurysms, and blood clots in the brain. They should also be aware how the procedure is to be performed, so they can anticipate what surgeons are to asked during the course of the surgery. They must always be in-the-know so they can execute nursing responsibilities and considerations appropriately for better patient outcome post-operatively.

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Awake Craniotomy will be featured on Methodist hospital webcast todayNew brain surgery allows patients to stay consciousBy Lindsay Melvin (Contact), Memphis Commercial Appeal Tuesday, April 21, 2009 Diagnosed with an aggressive cancer referred to even in medical publications as "The Terminator," Sheila Mullins couldn't find a neurosurgeon who would go near her brain tumor. "They said it would leave me paralyzed," said the Oakland resident, who has stage four glioblastoma multiforme. Scott Fowler/Special to The Commercial Appeal UT neurosurgical chief resident Dr. Jay Weimar (left) and Dr. Allen K. Sills perform an "Awake Craniotomy" at Methodist.STORY TOOLS

After months of her body being racked by seizures, she finally found a doctor who could remove the tumor safely. In May, while surgeons scraped her brain of cancerous cells, Mullins lay on the operating table reciting the alphabet and wiggling her toes and fingers. The "Awake Craniotomy" allowed her to stay conscious during the surgery so doctors could monitor her speech and other functions as they fiddled with a tumor resting on key functions of her brain. People can view the Awake Craniotomy performed on Mullins when Methodist University Hospital streams a webcast of the procedure today. Questions about the hourlong webcast will be answered live between 4 and 5 p.m. The procedure has been in the spotlight recently since U.S. Sen. Ted Kennedy underwent an Awake Craniotomy last year to remove a tumor. Executing these awake surgeries for the last decade, Methodist is the only facility in the Mid-South qualified to do the procedure. The hope is that by educating the public that this procedure is painless and safer than brain surgery of the past, Methodist hopes to expand its visibility to patients and referring doctors, hospital officials say. "All of us fear the unknown, particularly when it comes to medical procedures," said Dr. Allen Sills, one of two neurosurgeons featured in the webcast. Very sick patients have refused brain surgery because they were too frightened, said the director of Methodist Healthcare's Neuroscience Institute.

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Sills is also associate professor of neurosurgery for the University of Tennessee Health Science Center. "Everyone wants to know if they're going to hurt or be uncomfortable," he said. "This helps the patient to know exactly what to expect." -- Lindsay Melvin: 529-2445

A new approach to brain surgery that leaves no scar behind.Staff Writer 9:33 AM CDT, April 8, 2009

More than half a million people will have brain surgery this year. Large scars and lenghty recoveries typically go along with the surgery. Now Doctors are using the eyes as the gateway to the brain to make surgery less invasive. Swelling aside, you'd never guess Mike Hogan had life-saving brain surgery just a few weeks ago. "The doctor ordered a CAT scan. When they did the CAT scan, the aneurysm showed up." Doctors determined the aneurysm was in danger of ruptureing. Hogan's surgeons used a new and unusual technique to treat it. Neurosurgeon Dr. Khaled Aziz "when we do the standard procedure we make an incision behind the hairline -- from here, all the way to here." Instead, surgeons fixed the aneurysm through a tiny hole in his eyelid. During the eyelid Craniotomy a Neuro-Opthamologist marks the eyelid crease then makes an incision and removes a small piece of bone from the patient's eye socket. Next a Neurosurgeon reaches the front of the brain, clips the blood vessel that feeds the aneurysm and then puts the bone back in place. Doctors say a smaller incision means a shorter hospital stay, faster recovery and less pain. "In the long run, I think this it's more helpful for the patient outcome rather than standard surgical approaches." Mike has no scar, little pain, and more importantly more time to watch his grandchildren grow up. "It's amazing what they can do." Doctor Aziz says the eyelid approach is not for every patient. It only works for patients who need brain surgery toward the front of the skull Neurosurgeons also use the eyelid surgery to operate on certain brain tumors. Copyright 2009, WQAD-TV

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II. Anatomy and Physiology The Nervous System The nervous system is a network of specialized cells that communicate information about an animals surroundings and its self, it processes this information and causes reactions in other parts of the body. It is composed of neurons and other specialized cells called glia, that aid in the function of the neurons. The nervous system is divided broadly into two categories; the peripheral nervous system and the central nervous system. Neurons generate and conduct impulses between and within the two systems. system The is peripheral nervous

composed of sensory neurons and the neurons that connect them to the nerve cord, spinal cord and brain, which make up the central nervous system. In response to stimuli, sensory neurons generate and propagate signals to the central nervous system which then process and conduct back signals to of the the muscles and glands. The neurons

nervous systems of animals are interconnected in complex arrangements and use electrochemical signals and neurotransmitters to transmit impulses from one neuron to the next. The interaction of the different neurons

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form neural circuits that regulate an organisms perception of the world and what is going on with its body, thus regulating its behavior. Nervous systems are found in many multicellular animals but differ greatly in complexity between species The central nervous system (CNS) is the largest part of the nervous system, and includes the brain and spinal cord. The spinal cavity holds and protects the spinal cord, while the head contains and protects the brain. The CNS is covered by the meninges, a three layered protective coat. The brain is also protected by the skull, and the spinal cord is also protected by the vertebrae. Brai