CRANIOTOMY

CRANIECTOMY /
CRANIOPLASTY
What is CRANIOTOMY?

▪A craniotomy is the surgical removal of part of

the bone from the skull to expose the brain.
▪Specialized tools are used to remove the
section of bone called the bone flap.
▪The bone flap is temporarily removed, then
replaced after the brain surgery has been done.
PURPOSES / INDICATIONS OF CRANIOTOMY

• Diagnosing, removing, or treating brain tumors

• Clipping or repairing of an aneurysm
• Removing blood or blood clots from a leaking blood vessel
• Draining a brain abscess, which is an infected pus-filled pocket
• Repairing skull fractures
• Repairing a tear in the membrane lining the brain (dura mater)
• Relieving pressure within the brain (intracranial pressure) by removing damaged or swollen
areas of the brain that may be caused by traumatic injury or stroke
• Treating epilepsy
• Implanting stimulator devices to treat movement disorders such as Parkinson's disease or
dystonia (a type of movement disorder)
CRANIAL SURGICAL APPROCHES
Before the procedure
• Your doctor will explain the procedure to you and you can ask questions.
• You will be asked to sign a consent form that gives permission to do the surgery. Read the
form carefully and ask questions if something is not clear.
• In addition to a complete medical history, your doctor will do a physical exam to ensure you
are in good health before you undergo the surgery. You may also need blood tests and other
diagnostic tests.
• You will receive a preoperative neurological exam that will be used to compare with
postoperative exams.
• You will be asked to fast before the procedure, generally after midnight.
• If you are pregnant or think you may be, tell your healthcare provider.
• Tell your doctor if you are sensitive to or are allergic to any medicines, latex, tape and
anesthetic agents (local or general).
Before the procedure con’t…
• Tell your doctor of all medicines (prescribed and over-the-counter) and herbal
supplements that you are taking.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any
anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood
clotting. It may be necessary for you to stop these medicines before the procedure.
• If you smoke, you should stop smoking as soon as possible before the procedure to
improve your chances for a successful recovery from surgery and to improve your
overall health status.
• You may be asked to wash your hair with a special antiseptic shampoo the night
before the surgery.
• You may receive a sedative before the procedure to help you relax.
• The areas around the surgical site will be shaved.
• Based on your medical condition, your doctor may request other specific preparation.
During the procedure
▪A craniotomy generally requires a
hospital stay of 3 to 7 days. You may
also go to a rehabilitation unit for
several days after your hospital stay.
Procedures may vary depending on
your condition and your doctor's
practices.
During the procedure
▪Generally, a craniotomy follows this process:
1.You will be asked to remove any clothing, jewelry, or
other objects that may interfere with the procedure.
2.You will be given a gown to wear.
3.An intravenous (IV) line will be inserted in your arm or
hand.
4.A urinary catheter will be inserted to drain your urine.
5.You will be positioned on the operating table in a
manner that provides the best access to the side of
the brain to be operated on.
During the procedure
▪ .

6. The anesthesiologist will continuously monitor your heart rate, blood

pressure, breathing, and blood oxygen level during the surgery.
7. Your head will be shaved and the skin over the surgical site will be
cleansed with an antiseptic solution.
8. There are various types of incisions that may be used, depending on
the affected area of the brain. An incision may be made from behind the
hairline in front of your ear and the nape of your neck, or in another
location depending on the location of the problem. If an endoscope is
used, the incisions may be smaller.
9. Your head will be held in place by a device which will be removed at
the end of the surgery.
10. The scalp will be pulled up and clipped to control bleeding while
providing access to the brain.
During the procedure
11. A medical drill may be used to make burr holes in the skull. A special
saw may be used to carefully cut the bone.
12. The bone flap will be removed and saved.
13. The dura mater (the thick outer covering of the brain directly
underneath the bone) will be separated from the bone and carefully cut
open to expose the brain.
14. Excess fluid will be allowed to flow out of the brain, if needed.
Microsurgical instruments, such as a surgical microscope to magnify the
area being treated, may be used. This can enable the surgeon a better
view of the brain structures and distinguish between abnormal tissue and
healthy tissue. Tissue samples may be sent to the lab for testing.
15. A device, such as a drain or a special type of monitor, may be placed
in the brain tissue to measure the pressure inside the skull, or intracranial
pressure (ICP). ICP is pressure created by the brain tissue, cerebral
spinal fluid (CSF), and blood supply inside the closed skull.
During the procedure
16. Once the surgery is completed, the surgeon will suture
(sew) the layers of tissue together.
17. The bone flap will be reattached using plates, sutures, or
wires.
18. If a tumor or an infection is found in the bone, the flap may
not be replaced. Also, if decompression (to reduce pressure in
the brain) is required, the bone flap may not be replaced.
19. The skin incision (scalp) will be closed with sutures or
surgical staples.
20. A sterile bandage or dressing will be applied over the
incision.
After the procedure
▪ IN THE HOSPITAL

Immediately after the procedure, you will be taken to a

recovery room for observation before being taken to
the intensive care unit (ICU) to be closely monitored.
In the ICU, you may be given medicine to decrease the
brain swelling.
WHAT TO MONITOR POST-OPERATIVELY:

▪ LOC
▪ PUPPILLARY REFLEXES (PERRLA)
▪ ASK PATIENT TO MOVE THE HANDS AND LEGS – TO CHECK IF THERE’S ANY
RESIDUAL WEAKNESS
▪ ASK THE PATIENT TO SPEAK - CHECK FOR ANY LANGUAGE DEFICITS
▪ CHECK FOR FULL ALERTNESS & CONSCIOUSNESS
▪ CHECK FOR BLEEDING, INFECTIONS, STROKE, SEIZURES, LEAKAGE OF CSF

▪IF ANY COMPLICATIONS OCCUR; THEY

HAVE TO BE MANAGE ACCORDINGLY…
DISCHARGE INTRUCTIONS TO THE PATIENT

▪ MEDICATIONS like anticonvulsants are usually given to prevent Sz

e.g. Carbamazepine (Tegretol), Gabapentin (Neurontin)
- Pain relievers
- Steroids – to manage brain swelling
▪ Advised patient to walk as much as possible according to their comfort and
convenience
▪ Patient may take a bath & shampoo their hair 3-5 days after discharge but instructed to
keep the wound clean and dry
▪ Advised not to lift objects beyond 3.5 kgs. to avoid pressure to the brain
▪ Gently advised them to refrain from smoking and drinking alcohol
 SKULL
FRACTURES
HEMATOMAS OF
THE BRAIN
EPIDURAL vs. SUBDURAL HEMATOMAS
BRAIN TUMOR
A brain tumor is a mass or
growth of abnormal cells in your
brain.
- Benign or Malignant
ANEURYSM
A brain aneurysm is a bulge or
ballooning in a blood vessel in
the brain. It often looks like a
berry hanging on a stem.

A brain aneurysm can leak or

rupture, causing bleeding into the
brain (hemorrhagic stroke).
BURR HOLES
CRANIOTOMY INSTRUMENTATION
- Gigli Saw
- Raney Scalp Clip
- Hudson Brace Hand Drill
- Electric Drill (Perforator)
- A. Microsurgical Scissors
- B. Jacobson Microvascular
Needle holder
- C. Rhoton Micro Forceps
CRANIOTOMY INSTRUMENTATION

3 Point Fixation Device

 BONE CUTTERS

RONGEUR KERRISON
ACCESSORY MATERIALS NEEDED FOR CRANIOTOMY