CRANIOTOMY and its nursing care management .pptx

nervous system

1. CRANIOTOMY

2. Surgical removal of a section of the skull in order to access the intracranial compartment. The portion of skull temporarily removed is called a bone flap, and it is placed back in its original position after the operation is completed, typically fastened into place with low-profile titanium plates and screws. " Craniectomy " refers to an operation wherein the bone flap is removed but not replaced

3. The smallest type of craniotomy is technically a “burr hole,” also known as trephination.  the burr hole serves as the entry port for the endoscope in a variety of intracranial approaches.

4. Indications Resection of  brain tumor Biopsy of abnormal brain tissue Removal of  brain abscess Evacuation of hematoma ( eg , epidural, subdural, and intracerebral ) Insertion of implantable hardware ( eg , deep brain stimulators [DBS ], Ommaya reservoir) Resection of epileptogenic focus/tissue Relieving elevated intracranial pressure ( craniectomy )

5. subdural electrodes for seziure monitoring

6. Clipping of cerebral aneurysm (both ruptured and unruptured )

7. Resection of  arteriovenous malformation  (AVM)

8. Microvascular decompression ( eg , for  trigeminal neuralgia )

9. Vp shunt

10. Contraindications Advanced age Poor functional status Severe cardiopulmonary disease Severe systemic collapse requiring intensive care support ( eg , sepsis, multiorgan failure)

11. Complications Postoperative craniotomy complications can be divided into early and late categories. EARLY hematoma Seizures Cerebrospinal fluid (CSF) leak: This can result from poor wound closure. Cerebral infarct: This is stroke caused by damage to a major artery or vein and can be caused by the craniotomy itself , Pneumocephalus : This is air within the cranium introduced through the craniotomy site. It may manifest as confusion, lethargy, headache, seizures, and nausea/vomiting.

12. Late complications Infection: This results from the introduction of some form of contamination into the surgical site (brain, subdural/epidural space, incision). It can manifest as fevers, rigors/chills, and other systemic symptoms . seizures

13. Patient Preparation medications that are considered "blood thinners" should be discontinued prior to surgery. These include nonsteroidal anti-inflammatory medications (NSAIDs, eg , aspirin and ibuprofen), antiplatelet agents ( eg , clopidogrel [Plavix]), and anticoagulant medications ( eg , warfarin [Coumadin]).

14. preoperative steroid therapy ( eg , with dexamethasone [ decadron ]) to reduce cerebral edema due to an intracranial mass lesion, as well as antiepileptic therapy ( phenytoin [ Dilantin ] or levetiracetam [ Keppra ]) if there is a significant concern for potential seizures. 

15. Intravenous antibiotic to be administered in the operating room approximatel y 30 minutes prior to the surgery ( eg , cefazolin [ Ancef ], vancomycin , clindamycin) with the goal of reducing the likelihood of wound infection from neighboring bacterial skin flora (most commonly  Staphylococcus aureus ). For some craniotomies, typically those involving a large mass lesion with significant underlying edema and brain shift, a diuretic ( mannitol ) is administered during skin incision for additional brain relaxation.

16. Skull clamp

17. SSI

18. Monitoring & Follow-up Immediate postcraniotomy care Neurological examinations are performed by the nursing staff every 1-2 hours, and any changes in neurologic status ( eg , confusion, lethargy, aphasia, cranial nerve deficit, weakness, numbness ) Systolic blood pressure is kept between 90-140 mm Hg, since pressures above this range place the patient at risk for hemorrhage into the operative site, while pressures too low may compromise cerebral perfusion

19. Antibiotics are continued for a total of 24 hours following the craniotomy. Dexamethasone is tapered depending on the surgery antiepileptics can also be given

20. Long-term monitoring Intraoperative monitoring devices are removed (arterial line, Foley bladder catheter), and the patient is encouraged to ambulate . The staples or sutures used to close the most superficial skin layer can be removed 5-10 days Follow up – after 1-2 weeks

21. Typically discouraged from a bath until 1–2 weeks later. Hair products other than baby shampoo are also discouraged for at least 2 weeks.  Patients may also be cautioned against flying for 1–4 weeks given the possibility of exacerbating air pockets ( pneumocephalus ) that are introduced into the intracranial space during the craniotomy. Changes in cabin pressure may induce severe headaches.

22. NEXT

23. What is a cranioplasty ? Cranioplasty refers to a surgical procedure to repair a defect in the skull.  There are different kinds of cranioplasties , but most involve lifting the scalp and restoring the contour of the skull with the original skull piece or a custom contoured graft made from material such as: Titanium (plate or mesh). Synthetic bone substitute