Craniotomy
Definition
It is a surgical procedure in which the
cranial cavity is entered by making an opening in the skull.
Indications
1.To elevate a depressed fracture of the
skull.
2.To drain an extradural haematoma.
3.To drain a subdural haematoma.
4.To remove a brain tumour.
5.To ligate a Berry aneurysm.
6.To prevent blindness in a case of
acromegaly due to compression of optic nerve.
7.To drain a brain abscess.
8.Ventriculography.
9.Ventriculoatrial shunt for hydrocephalus.
Preoperative
care
1.A complete neurological assesement is
done to find out the exact neurological deficit present.
2.The procedure is explained to the patient
and his relatives and their informed consent is obtained.
3.If the patient is aphasic, he is given a
piece of paper and pencil to write down what he wants to say.
4.See chapter 4 for general preoperative
care.
Postoperative
care
1.See chapter 4,for postoperative care
after major surgery.
2.Complete bed rest is given.
3.He is kept in a room which is clean and
air, but without a blast of air coming on him directly.
4.He is put on a Dunlop bed, and if that is
not available, a cotton bed, but not a coir bed. A water bed is ideal for
preventing bed sores.
5.His bed should be made every day. It
should be clean, dry, and warm.
6.His position should be changed every 2
hours, so that, he does not develop bed sores.
7.The back and the pressure points are
dried and cleaned with spirit every 2 hours to prevent bed sores.
8.He should be sponged every day.
9.His vital parameters are recorded half
hourly.
10.Input and output chart is maintained.
11.Oral hygiene is maintained.
12.Intravenous fluids are given. Oral
liquids are started after the first
three days.
13.A bowel movement is ensured every day.
14.Vomiting is observed and the findings
are recorded.
15.Nails are cut once a week.
16.Hair bath is given once a week.
17.Antibiotics are given as prescribed by
doctor.
Complications
1.Meningitis.
2.Injury to brain and neurological damage.
3. infections (surgical site inspection, osteomyelitis- bone flap infection)
4. cerebrospinal fluid leak: leakage of the fluid surrounding the brain and spinal cord through the incision or nose/ears.
brain swelling or increases intracranial pressure (ICP): Excess fluid and swelling inside the skull that can place pressure on brain tissue.
5. seizures : New or recurrent seizure activity following brain irritation or surgery.
6. stroke or cerebral infarction : restricted blood flow or damage to critical blood vessels during the procedure.
7. hydrocephalus : abnormal buildup of CSF in the brain's ventricles, sometimes requiring a temporary or permanent drain/shut.
8. tension pneumocephalus: Trapped air inside the skull creating mass effect.
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