Craniotomy

Craniotomy

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Craniotomy

Intervention

ICD-9-CM 01.2

MeSH D003399

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A craniotomy is a surgical operation in which a bone flap is temporarily removed from the skull to access the brain. Craniotomies are often critical operations, performed on patients who are 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. The procedures are used for accessing brain tissue that must be removed, as well.

Craniotomy is distinguished from craniectomy (in which the skull flap is not immediately replaced, allowing the brain to swell, thus reducing intracranial pressure) and from trepanation, the creation of a burr hole through the cranium in to the dura mater.

Contents [hide]  1Procedure

 2Complications  3See also

 4References  5External links

Procedure

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Diagram of the elements of a craniotomy.

Human craniotomy is usually performed under general anesthesia but can be also done with the patient awake using a local anaesthetic; the procedure, typically, does not involve significant

discomfort for the patient. In general, a craniotomy will be preceded by an MRI scan which provides an image of the brain that the surgeon uses to plan the precise location for bone removal and the 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. The bone flap is then replaced using titanium plates and screws or another form of fixation (wire, suture, etc.).

Complications

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Bacterial meningitis or Viral meningitis occurs in about 0.8 to 1.5% of individuals undergoing

craniotomy.[1] _{Postcraniotomy pain is frequent and moderate to severe in nature. This pain has been} controlled through the use of: scalp infiltrations, nerve scalp blocks, parecoxib, andmorphine, morphine being the most effective in providing analgesia.

According to the Journal of Neurosurgery, Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis, their clinical studies indicated that, “…the risk for meningitis was independently associated with perioperative steroid use and ventricular drainage.” Within the 334 procedures that they had conducted from males and females, their results concluded that traumatic brain injuries were the predominant causes of bacterial meningitis.

At least 40% of patients became susceptible to at least 1 infection, creating more interconnected risk factors along the way. From the Infectious Diseases Clinic Erasme Hospital, there had been reports of infections initially beginning from either the time of surgery, skin intrusion, hematongenous seeding, or retrograde infections.

Cerebrospinal fluid shunt (CSF) associates with the risk of meningitis due to the following factors: pre-shunt associated infections, post-operative CSF leakage, lack of experience from the

neurosurgeon, premature birth/young age, advanced age, shunt revisions for dysfunction, and neuroendoscopes.

The way shunts are operated on each patient relies heavily on the cleanliness of the site. Once bacteria penetrates the area of a CSF, the procedure becomes more complicated.

The skin is especially necessary to address because it is an external organ. Scratching the incision site can easily create an infection due to no barrier between the open air and wound.

Aside from scratching, decubitus ulcer and tissues near the shunt site are also leading pathways for infection susceptibility.

[2]

It is also common to give patients seven days of anti-seizure medications post operatively.

Traditionally this has been phenytoin, but now is increasingly levetiracetam as it has a lower risk of drug-drug interactions. [3][4]

See also

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 Craniotome (tool)

 Decompressive craniectomy  Trepanning

References

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1. Jump up ^ van de Beek D, Drake JM, Tunkel AR (January 2010). "Nosocomial Bacterial Meningitis".New England Journal of Medicine 362 (2): 146–

154. doi:10.1056/NEJMra0804573.PMID20071704.

2. Jump up ^ Hansen, Morten S; Brennum, Jannick; Moltke, Finn B.; Dahl, Jørgen B. (December 2011). "Pain treatment after craniotomy: where is the (procedure-specific) evidence? A qualitative systematic review". European Journal of Anaesthesiology 28 (12): 821–

829.doi:10.1097/EJA.0b013e32834a0255.

3. Jump up ^ Szaflarski, J. P; K. S Sangha; C. J Lindsell; L. A Shutter (2010). "Prospective, randomized, single-blinded comparative trial of intravenous levetiracetam versus phenytoin for seizure

prophylaxis". Neurocritical care 12 (2): 165–172. doi: 10.1007/s12028-009-9304-y.

4. Jump up ^ Temkin, N. R; S. S Dikmen; A. J Wilensky; J. Keihm; S. Chabal; H. R Winn (1990). "A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures".New England Journal of Medicine 323 (8): 497–

502.doi:10.1056/nejm199008233230801.

External links

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[hide]

 v

 t

 e

Surgery, Nervous system: neurosurgical and other procedures (ICD-9-CM V3 01–05+89.1,

Skull Craniotomy Decompressive craniectomy Cranioplasty CNS Brain

thalamus and globus pallidus:

Thalamotomy Thalamic stimulator Pallidotomy ventricular system: Ventriculostomy Suboccipital puncture

Intracranial pressure monitoring

cerebrum:

Psychosurgery Lobotomy

Bilateral cingulotomy Hemispherectomy

Anterior temporal lobectomy

pituitary gland: Hypophysectomy

hippocampus: Amygdalohippocampectomy

Brain biopsy

Spinal cord and spinal canal

Spinal cord and roots

Cordotomy Rhizotomy

Vertebrae and intervertebral discs: see Template:Bone, cartilage, and joint procedures

Medical imaging

Computed tomography of the head Cerebral angiography

Pneumoencephalography

Echoencephalography/Transcranial Doppler Magnetic resonance imaging of the brain Brain PET Myelography Diagnostic Electroencephalography Lumbar puncture Polysomnography CPRs

Glasgow Coma Scale

Mini–mental state examination

National Institutes of Health Stroke Scale CHADS2 score

PNS

Cranial and peripheral nerves Nerve block

Vagotomy

Sympathetic nerves or ganglia

Ganglionectomy Sympathectomy

Endoscopic thoracic sympathectomy

Nerves (general) Axotomy Neurectomy

Nerve biopsy

Diagnostic Nerve conduction study

Electromyography

Medical imaging Magnetic resonance neurography

 v

 t

 e

Index of the central nervous system

Description Anatomy meninges cortex association fibers commissural fibers lateral ventricles basal ganglia diencephalon mesencephalon pons cerebellum medulla spinal cord tracts Physiology neutrotransmission enzymes intermediates Development

Disease

Addiction Cerebral palsy Meningitis

Demyelinating diseases Seizures and epilepsy Headache

Stroke Sleep Congenital Injury

Neoplasms and cancer Other

paralytic syndromes ALS

Symptoms and signs head and neck eponymous lesions Tests CSF Treatment Procedures Drugs general anesthetics analgesics dependence epilepsy cholinergics migraine Parkinson's vertigo other  v  t

 e

Index of the peripheral nervous system

Description Anatomy Nerves cranial trigeminal cervical brachial lumbosacral plexus somatosensory spinal autonomic Physiology reflexes proteins neurotransmitters transporters Development neurotrophins Disease Autonomic Congenital Injury

Neoplasms and cancer Other

Symptoms and signs eponymous Treatment Procedures Local anesthetics Categories:  Neurosurgery

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