Neuro & Brain
Like any other part of the body, the brain is susceptible to bleeding, infection, trauma and other forms of damage. This damage or alteration in brain function sometimes requires brain surgery to diagnose or treat these problems.
What is Craniotomy?
The Craniotomy is a surgery used to cut a bony opening in the skull. A part of the skull, (called as the bone flap) is removed to access the brain underneath. A craniotomy may be
small or large depending on the problem of the patient. The surgeon uses special tools to remove the section of bone called the bone flap. After the brain surgery, the surgeon
replaces the bone flap and attaches it to the surrounding bone with the help of small titanium plates and screws. If the part of the skull bone is removed and is not replaced right
away, it is called craniectomy. This is performed if the swelling is likely to occur after brain surgery or if the skull bone flap can't be replaced for other reasons. After a few
weeks to months, the patient may have to follow-up surgery called a cranioplasty. During a cranioplasty, the missing piece of the skull will be replaced with your original bone, a
metal plate, or with a synthetic material.
Why do I need Craniotomy?
Doctors may perform a craniotomy for a variety of reasons, these reasons may include:
• Diagnosing, removal, or treating brain tumors,
• Clip or repairing an aneurysm,
• Removal of blood or blood clots from a leaking blood vessel,
• Removing an arteriovenous malformation. This is an abnormal mass of blood vessels,
• Draining an infected pus-filled pocket (abscess)
• Repairing skull fractures,
• Repairing a tear in the membrane lining of the brain,
• Relieving pressure within the brain (intracranial pressure) by removing damaged or swollen areas of the brain that may be caused due to traumatic injury or stroke
• Treating epilepsy. This is a neurological condition which involves the brain that makes people more likely to have seizures.
• Implanting stimulator devices for treating movement disorders such as Parkinson disease or a type of movement disorder called dystonia
• Treating hydrocephalus
Do’s and don’ts before the surgery:
Before the Surgery:
• The Patient may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before the surgery takes place.
• The Surgeon must be correct medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, and previous surgeries) by the patient.
• The patient must discuss all medications (prescription, over-the-counter, and herbal supplements) that he/she is taking.
• All non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) and blood thinners (Coumadin, Plavix, etc.) must be avoided 1 to 2 weeks before
surgery as directed by the doctor.
• Additionally, smoking, chewing tobacco, and drinking alcohol must be prohibited 1 week before and 2 weeks after the surgery because these activities can cause bleeding problems.
• No food or drink is permitted past midnight the night before surgery takes place.
Morning of surgery
• Shower with the help of antibacterial soap. Wear loose fitting and freshly washed clothes.
• Wear flat-heeled shoes having closed backs.
• If the patient has been given instructions to take regular medication the morning of surgery, do so with small sips of water.
• Remove any make-up, hairpins, contacts, body piercings, nail polish, etc.
• Leave all valuables and jewelry at home.
• Patient must have a list of medications with dosages and the times of day usually taken.
• Patient must have a list of allergies to medication or foods.
• Arrive at the hospital 2 hours prior to the scheduled surgery time to complete the necessary paperwork and pre-procedure work-ups.
Procedure for Craniotomy:
The Human craniotomy is usually performed under general anesthesia but it can be also performed with the patient awake using a local anesthetic. This procedure generally does not
involve significant discomfort for the patient. A craniotomy will be preceded by an MRI scan which provides an image of the brain that the surgeon uses to pinpoint the precise
location for bone removal and find an appropriate angle of access to the relevant brain areas. The amount of skull that needs to be removed depends on the type of surgery being
performed by the surgeon. The bone flap is mostly removed with the help of a cranial drill and then it is replaced using titanium plates and screws or another form of fixation like
wire, suture, etc. If the host bone does not accept its replacement an artificial piece of skull, often made of PEEK, is substituted. The patient may experience a headache or even
nausea after surgery. Medication will help in controlling these symptoms. Depending on the type of brain surgery, steroid medication (to control brain swelling) and anticonvulsant
medication (to prevent seizures) may be given to the patient.
The length of the hospital stay may vary, from only 2–3 days or 2 weeks depending on the surgery and any complications.
Risks involved during Craniotomy:
All treatment and outcome may vary from patient to patient. Complications such as infection, nerve damage, blood clots, blood loss, bowel and bladder problems, along with
complications associated with anesthesia, are some of the potential risks of spinal surgery.
Complications associated with a craniotomy may include:
• Brain swelling, which may require another craniotomy
• Nerve damage which results in muscle weakness or even paralysis
• Cerebrospinal fluid leak
• Mental impairment
• Permanent brain damage and associated disabilities
The following complications are rare and are only related to specific places in the brain:
• Memory problems
• Speech difficulty
• Abnormal balance or coordination
The patient will be given a follow-up appointment for 10 to 14 days after surgery. The recovery time may vary from 1 to 4 weeks depending on the underlying disease being treated and
the patient’s general health. Full recovery may even take up to 8 weeks. Walking is a good way to begin increasing a person activity level. One mustn’t overextend himself/herself,
especially if that person is continuing treatment with radiation or chemotherapy. One must ask his/her surgeon when he/she can return to work.
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