crainiotomy

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    CraniotomyRequirement

    Surgical removal of part of the skull to expose the brain.

    2011

    Ramos, Raymond Carlou M.

    BSN 4F/Group 22

    12/12/2011

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    Definition

    A craniotomy is a procedure to remove a lesion in the brain through an opening inthe skull (cranium).

    Purpose

    A craniotomy is a type of brain surgery. It is the most commonly performed surgeryfor brain tumor removal. It also may be done to remove a blood clot (hematoma), tocontrol hemorrhage from a weak, leaking blood vessel (cerebral aneurysm), torepair arteriovenous malformations (abnormal connections of blood vessels), todrain a brain abscess, to relieve pressure inside the skull, to perform a biopsy, or toinspect the brain.

    Demographics

    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 primary braincancers 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 arepresently the most common cancer in children (four out of 100,000).

    Description

    There are two methods commonly utilized by surgeons to open the skull. Either anincision is made at the nape of the neck around the bone at the back (occipitalbone) or a curving incision is made in front of the ear that arches above the eye.

    The incision penetrates as far as the thin membrane covering the skull bone. Duringskin incision the surgeon must seal off many small blood vessels because the scalphas a rich blood supply.

    The scalp tissue is then folded back to expose the bone. Using a high-speed drill,the surgeon drills a pattern of holes through the cranium (skull) and uses a fine wiresaw to connect the holes until a segment of bone (bone flap) can be removed. Thisgives the surgeon access to the inside of the skill and allows him to proceed withsurgery inside the brain. After removal of the internal brain lesion or otherprocedure is completed, the bone is replaced and secured into position with softwire. Membranes, muscle, and skin are sutured into position. If the lesion is ananeurysm, the affected artery is sealed at the leak. If there is a tumor, as much of it

    as possible is resected (removed). For arteriovenous malformations, theabnormality is clipped and the repair redirects the blood flow to normal vessels.

    http://www.surgeryencyclopedia.com/St-Wr/Tumor-Removal.htmlhttp://www.surgeryencyclopedia.com/St-Wr/Tumor-Removal.html
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    Diagnosis/Preparation

    Since the lesion is in the brain, the surgeon uses imaging studies to definitivelyidentify it. Neuroimaging is usually accomplished by the following:

    CT (computed tomography, uses x-rays and injection of an intravenousdye to visualize the lesion)

    MRI ( magnetic resonance imaging , uses magnetic fields and radio wavesto visualize a lesion)

    In a craniotomy, the skin over a part of the skull is cut and pulled back (A). Smallholes are drilled into the skull (B), and a special saw is used to cut the bonebetween the holes (C). The bone is removed, and a tumor or other defect isvisualized and repaired (D). The bone is replaced (E), and the skin closed (F). (

    Illustration by GGS Inc.

    )

    Arteriogram (an x-ray of blood vessels injected with a dye to visualize a tumor orcerebral aneurysm)

    Before surgery the patient may be given medication to ease anxiety and todecrease the risk of seizures, swelling, and infection after surgery. Blood thinners

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    (Coumadin, heparin, aspirin ) and nonsteroidal anti-inflammatory drugs (ibuprofen,Motrin, Advil, aspirin, Naprosyn, Daypro) have been correlated with an increase inblood clot formation after surgery. These medications must be discontinued at leastseven days before the surgery to reverse any blood thinning effects. Additionally,the surgeon will order routine or special laboratory tests as needed. The patientshould not eat or drink after midnight the day of surgery. The patient's scalp is

    shaved in the operating roomjust before the surgery begins.

    Aftercare

    Craniotomy is a major surgical procedure performed under general anesthesia.Immediately after surgery, the pa tient's pupil reactions are tested, mental status isassessed after anesthesia, and movement of the limbs (arms/legs) is evaluated.

    Shortly after surgery, breathing exercises are started to clear the lungs. Typically,after surgery patients are given medications to control pain, swelling, and seizures.Codeine may be prescribed to relive headache. Special leg stockings are used toprevent blood clot formation after surgery. Patients can usually get out of bed inabout a day after surgery and usually are hospitalized for five to 14 days aftersurgery. The bandages on the skull are be removed and replaced regularly. Thesutures closing the scalp are removed by the surgeon, but the soft wires used toreattach the portion of the skull that was removed are permanent and require nofurther attention. Patients should keep the scalp dry until the sutures are removed.If required (depending on area of brain involved), occupational therapists andphysical therapist assess the patient's status postoperatively and help the patientimprove strength, daily living skills and capabilities, and speech. Full recovery may

    take up to two months, since it is common for patients to feel fatigued for up toeight weeks after surgery.

    Risks

    The surgeon will discuss potential risks associated with the procedure.Neurosurgical procedures may result in bleeding, blood clots, retention of fluidcausing swelling (edema), or unintended injury to normal nerve tissues. Somepatients may develop infections. Damage to normal brain tissue may cause damageto an area and subsequent loss of brain function. Loss of function in specific areascan cause memory impairment. Some other examples of potential damage thatmay result from this procedure include deafness, double vision, numbness,

    paralysis, blindness, or loss of the sense of smell.

    Normal results

    Normal results depend on the cause for surgery and the patient's overall healthstatus and age. If the operation was successful and uncomplicated recovery isquick, since there is a rich blood supply to the area. Recovery could take up to eightweeks, but patients are usually fully functioning in less time.

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    Morbidity and mortality rates

    There is no information about the rates of diseases and death specifically related tocraniotomy. The operation is performed as a neurosurgical intervention for severaldifferent diseases and conditions.

    Alternatives

    There are no alternative treatments if a neurosurgeon deems this procedure asnecessary.