Craniotomy

Craniotomy is a surgical procedure in which the ‘bone covering’ of the skull is removed to access the brain for further surgical procedures. Specialized instruments and tools are required to perform this procedure. The covering of the brain known as the bone flap is removed before the operation and replaced once the surgical procedure has been completed. Use of computerized guidance system is normal for this kind of procedure.

The procedure of Craniotomy, if prescribed by your physician, means that there is some problem with the brain or its related parts that requires surgical intervention. The surgical procedure is applied only in the case of severe or important problems. The reasons for which the physician may prescribe such a procedure are:

• Brain tumors: This procedure may be used for detecting and taking out brain tumors.
Brain Aneurysm: An aneurysm is a blockage in the main artery of the brain. Carniotomy may be used to administer a clipping or the repairing of that aneurysm. Clearing blood clots: Removing blood or blood clots from the brainis done by Craniotomyy Treating disfigurement: Craniotomy may be used for removing an arteriovenous deformity or addressing a fistula present inside the artery or vein. Draining Abscesses:Craniotomy may be used drain out a pus-filed infected pocket in the brain, also known as the brain abscess. Repairing skull fractures:This may be done by Craniotomy to repair any crack developed in the external or internal face of the skull. Treating Dura matter: The Dura matter is the lining of the human brain. If, by any chance, a tear or crack develops in this external lining, Craniotomy can be used to repair it. Reducing pressure: Due to some traumatic injury or cerebral stroke, the pressure inside the cranial compartment may increase. Craniotomy may be used to remove the swollen or damaged area to reduce the intracranial pressure. Epilepsy treatment: Craniotomy can be used to give a surgical treatment of Epilepsy. Management of motor disorder: Craniotomy may be applied to manage movement disorders like Parkinson’s syndrome or dystonia in human patients.

Causes

There are several causes that may require Craniotomy for the resolution. The neurological surgeons will decide on the procedure that is required for the patient to undergo the surgery. Some of the causes that require the surgical method of Craniotomy to be applied for the patients are;

• Brain Cancers: The uncontrolled and malignant growth of the cells in the brain is known as the brain cancer. It gives rise to a tumor, which may increase the pressure inside the brain, or make obstruction in the blood flow of the cranial blood vessels. Often, to surgically remove the tumor or clip the blockage in the brain, Craniotomy is required.
• Infections: Infection by different bacteria, especially the genus of Meningococcus, that causes toxicity in the brain.The surgical removal of the affected part may be required, and the way to access the brain is Craniotomy.
• Abscesses: The puss-filled cavities of the brain, often infected, may be accessed by the procedure of Craniotomy.
• Cerebral edema: Accumulation of fluid inside the brain cavity may cause swelling in the organ, and henceforth need Craniotomy for the drainage.
• Intracranial bleeding: Internal bleeding occurring within the skull may increase the blood pressure inside the brain. To clear the bleeding from the brain, the method of Craniotomy will be needed to be applied.

Symptoms

As the problems requiring Craniotomy is situated within the brain, it is not easily discernible by any specific symptoms or indications. Normally, changes or detriment in the motor functions of the affected person is seen, and quick action is required for the patient to determine whether that person needs Craniotomy or not. The general symptoms that may make your surgeon consider a Craniotomy can be listed as

• Continuously increasing drowsiness
• Difficulty in walking or feeling weakness in your legs, arms or face
• Facing confusion or having trouble remembering things
• Experiencing double vision or blurred vision
• Stiffness in the neck
• The skull showing erythrima (signs of redness), swelling, leaking fluid or feeling warm to touch
• Pain, swelling or redness in forelimbs or legs
• Fitsor seizures
• Twitching or involuntary jerking of limbs

Diagnosis:

The diagnostic tests that may ensure a Craniotomy is not disease-specific, as any complications within the brain not treatable by medicines can be a candidate for Craniotomy. So, the techniques that may confirm the need of Craniotomy can be listed a

• Neurological Exam: These tests are performed to check the vision, hearing, balance, coordination, strength and reflexes of the patients. Difficulty in one area can tell the area of interest for the patient.
• Magnetic Resonance Imaging: Magnetic fields are used to determine any complication within the brain. Sometimes a dye may be used.
• Biopsy: Tissue samples are taken from the areas of the brain and tested for any problems.

Risk Factors

Craniotomy is an intrusive method so there are some risks involved. There may be a chance of the following risks

• Infection
• Bleeding
• Blood clots
• Pnemunia
• Fluctuating blood pressure
• Seizures
• Muscle weakness
• Outflow of cerebrospinal fluid

Post Operativve Care

• The patient would be in the intensive care unit (ICU) for a day or two.
• He or she will be given nutrition, medication, fluids through an intravenous route.
• A catheter may be placed to assist the voiding of urine.
• The incision site will be monitored for any infection
• Motor and cognitive functions will be checked from time to time.
• Mild physical and breathing exercises may be given.

TREATMENT

After it has been established that the management can no longer continue with medications, the physician will most likely go for surgery. The guidelines the physician may give you to follow before and during the procedure are:

Before Treatment

• Your doctor will clarify the procedure to you and you can ask any enquiries.
• In addition to a comprehensive medical history, a physical exam may be done before the operation.
• You will be tested for neurological problems before the surgery.
• You will not be given food or drink before surgery.
• All medicines and herbal supplements that you are taking must be mentioned.
• You may receive a tranquillizer at the start of the surgery.
• The areas around the operating site will be shaved.

During the Surgery:

• You will be positioned on the operating table in a manner that provides the best access to the operableside of the brain.
• Your head will be shaved and the skin over the surgical site will be cleansed with an antiseptic solution
• Your head will be held in place by a support which will be removed at the end.
• The covering of the brain will be lifted.
• The Dura mater will be incised to access the brain.
• Extra fluid will be allowed to drain out of the brain. The surgeon may use sophisticated instruments to judge the state of the brain.
• The tissues would be stitched back together after the operation
• The covering would be attached again.
• The incision will be closed.
• A medicated bandage will be applied over the incision.