Prepared by Honey Bee S.

Platolon
 ➢ Introduction

What is “CRANIOTOMY”?
A craniotomy is type of brain
surgery. It involves removing
part of the skull, or cranium, to
access the brain. The bone is
replaced when the surgery is
done.
➢ Purpose of the Surgery

➢ Diagnosing, removing, or treating brain tumors

➢ Clipping or repairing of an aneurysm
➢ Removing blood or blood clots from a leaking blood vessel
➢ Removing an arteriovenous malformation (AVM) or addressing an arteriovenous fistula
(AVF)
➢ 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)
➢ Treating epilepsy
➢ The Procedure

❖PREPARATION
• Tests are ordered by the doctor several days before the procedure. These tests include
blood tests, chest x-ray, electrocardiogram as well as a brain scan by MRI, CT, or PET.
• The patient should not take anti-inflammatory medicines or blood thinners, for at least one
week before the procedure. The doctor may prescribe medications to take prior to surgery
to remove anxiety and/or prevent procedure swelling, infection or seizures after surgery.
• The patient should stop smoking, chewing tobacco, and drinking alcohol for 1-2 weeks
before the surgery since these are known to cause complications during and after surgery
and thereby slowing down the healing process.
• The patient should not eat or drink anything for at least 8 – 12 hours before the procedure.
• Just before the procedure, the patient’s head is shaved over the area where the craniotomy
will be done. The scalp is usually shaved in the shape of a small horse-shoe.
➢ The Procedure

❖ANESTHESIA
Two broad categories of anesthesia are used for a craniotomy:
local and general. Most craniotomies involve both methods of
anesthesia; local anesthetic is injected into the incision site for
superficial hemostasis and postoperative pain control, while general
endotracheal anesthesia (GETA) is administered for the duration of the
operation.
➢ During the surgery

• Once anesthesia takes effect and the patient is asleep, the head is help in a fixed position using
a 3-pin skull fixation device. Next, a drain is placed in the lower back to drain off the
cerebrospinal fluid secreted in the brain and passed through the spinal column. Removing the
spinal fluid helps relieve pressure from the brain during surgery. The scalp is then prepped
with an antiseptic and an incision made on the skin. The incision may be made either around
the occipital bone at the nape of the neck or a curved incision above the ear and eye. Care is
taken to avoid the hairline; however, if the surgeon thinks it is needed he may shave a part of
the head and cut there.
• Once the incision is made, the skin, muscles and tissues of the scalp are then folded back and
the skull is exposed. Next, small holes are drilled in the skull using a high speed drill and a
bone saw to cut out a flap through the holes. This bone flap is then removed to expose the
brain tissues at the area the surgeon will do surgery or examination.
• Then, the bone flap is put back in place and held with soft wires, plates and screws. The
surgeon may choose to place a drain under the skin to remove blood and fluid from the site of
the surgery. The drain may stay in place for 1-2 days. The skin and muscles are then sewn
together. Finally, a bandage or dressing is put over the incision.
➢ After the Surgery

• After the surgery, the patient is taken to the recovery room and watched
closely. The vital signs (that is, temperature, blood pressure, heart rate, and
breathing) are monitored. The breathing tubes and catheters are usually left in
place and a drip may be put into a vein to give fluids. After the patient wakes
up, the patient is then transferred to the ICU (intensive care unit) for further
neurological observation. The patient is asked to do simple commands like
move their hands, legs, fingers, toes to check for complications from surgery.
• Nausea and headaches are common after a craniotomy. Medicines can be
given to control these along with seizures and swelling in the brain following
surgery.
• If everything is going as expected, the patient is transferred to a regular
hospital room, where the patient may stay for 3-14 days depending on the
type of brain surgery and if there are any complications.
➢ Instruments
SOLID BAR HANDLE FOR
GIGLI SAW
JANSEN RETRACTOR used for sawing bones,
used for retraction during commonly amputations, but
mastoid surgical procedures. may also be used in
neurosurgery for cutting
cranial flaps.

WEITLANER RETRACTOR
used to deviate and hold ADSON FORCEPS
tissues. used for handling dense
tissue, such as in skin
closures, holds objects, or
provide hemostasis.

SCALPEL HANDLE
intended to be use with
BACKHAUS TOWEL CLAMP
surgical blades for tissue
used for grasping tissue,
separation and other procedure
securing towels or drapes,
that require a sharp surgical
and holding or reducing
blade to puncture or cut.
small bone fractures.
➢ Instruments
STILLE-LISTON BONE
CUSHING BRAIN FORCEPS FORCEPS
used on delicate tissue Used for cutting through hard
bony texture to get better
access to the surgical site.
RUSKIN RONGEUR
used for clearing space or
MAYO HEGAR Nh
scooping out in bone to
increase access to the surgical used to hold a suturing
area or bone remodeling. needle during surgical
procedures.
FOERSTER SPONGE
FORCEPS
firmly clasp gauze squares that GIGLI SAW WIRE
will hold abundant fluids and used for cutting through
blood from the opera table the skull in brain
region or surgical hemostasis.
surgery.
HALSTED MOSQUITO
FORCEPS METZENBAUM
clamping vessels and DISSECTING SCISSOR
controlling blow flow and other or cutting delicate tissue
clamping tasks in general and blunt dissection.
surgical procedures.
➢ Risk and Complications

Complications from craniotomy are usually of 3 types:

▪ Those normally associated with any kind of surgery.
▪ Those related to the craniotomy procedure
▪ Those related to the surgery done on brain and nerves after the
craniotomy
The common risks associated with any types of these surgery include
bleeding; infections; blood clots; risks related to anesthesia like light-
headedness, low blood pressure, etc.
➢ Preoperative Care

• Protection of the CNS is the major priority of care for the patient awaiting a
craniotomy.
• Detailed assessment and documentation of the patient’s preoperative neurological
status are imperative for accurate post operative evaluation.
• In pituitary patient, evaluation of endocrine function is necessary to prevent
intraoperative and postoperative complication.
• Routine preoperative screening should be performed (CBC, BUN, FBS, chest x-
ray, ECG, cross match).
• Preoperative teaching is important to both patient and family about post operative
period, which include the following issues
• Patient should know that all or part of his/her head’s hair will be shaved to do the
operation; facial edema, suspected complications such as infection, hemorrhage,
anesthesia problems, and also suspected neurological deficit.
➢ Intraoperative Care

• Prepares the surgical set-up

• Maintains surgical asepsis while draping and handling
instruments
• Assists the surgeon by passing instruments, sutures, and
supplies.
• Respond to request from the surgeon, anesthesiologist or
anesthetist
• Obtain supplies, deliver supplies to the sterile field, and carry
out the nursing care plan.
➢ Postoperative Care

• Preserving adequate cerebral perfusion

• Promoting arterial oxygenation
• Providing comfort and emotional support
• Maintain surveillance for complications
• Educate the patient on deep-breathing exercises to help re-expand the
lungs and prevent pneumonia.
• Frequent neurological checks will be done by to test the brain for
function and to make sure body systems are functioning properly after
your surgery.
• Initiating early rehabilitation