Craniotomy.pptx

What is Craniotomy?
What are the Indications for Craniotomy?
What are the Types of Craniotomy?
Equipment used in craniotomy?
What happen to the Bone flap?
What are the Tests Done Prior to Craniotomy?
What happens during surgery?
What are the risks?
References

1. Craniotomy Presenter – Rahul Sharma

2. Learning Objectives What is Craniotomy? What are the Indications for Craniotomy? What are the Types of Craniotomy? Equipment used in craniotomy? What happen to the Bone flap? What are the Tests Done Prior to Craniotomy? What happens during surgery? What are the risks? References

3. H istorical context and Perspective Dating back to 2300 years , trephination is the oldest cranial surgical technique. End of 19 th century self-educated surgeon Wilhelm Wagner introduce current modern surgical technique for a craniotomy for the final cured result.

4. What is Craniotomy ? It is a Surgical procedure A part of skull is temporarily removed to expose the brain and perform an intracranial procedure .

5. Indications Brain injury following trauma is one of commonest indications for craniotomy. Craniotomy usually done for Surgical removal of a tumor or blood clot (hematoma)

6. Clipping of an aneurysm Clipping of aneurysm reduces blood flow through it and therefore decreases its size and its potential to burst.

7. Removal of an A rteriovenous Malformation Abnormal communication between an artery and a vein Bleeding can result in grave consequences.

8. Ventricular shunting Procedure performed to reduce pressure in the skull due to excess fluid accumulation.

9. Other indication can be:- Decompressive by draining abscess Lobectomy Epilepsy surgery Craniosynostosis Cerebrospinal fluid leak repair Other procedures like inserting deep brain stimulators for the treatment of conditions Parkinson’s disease, essential tremor and  dystonia

10. What are the Types of Craniotomy ? It can be classified into several types depending on location . Frontal craniotomy Temporal craniotomy Parietal craniotomy Occipital craniotomy Pterional craniotomy

11. Extended Bifrontal Craniotomy Traditional skull base approach Incision given in scalp behind the hairline Target difficult tumors at frontal part of brain Bone remove forms contour of orbits and forehead

12. Principle behind bifrontal craniotomy Allows surgeons to work in space between and right behind eyes without having to unnecessarily manipulate the brain Indication Mainly those tumors not exposed by minimal invasive approaches including, Meningiomas   Esthesioneuroblastomas Malignant  skull base tumors  

13. Minimally Invasive Supra-Orbital “ eyebrow” Craniotomy Small incision made within eyebrow Helps to access Tumors in front of brain Pituitary gland tumor Tumors deeper in brain behind nose and eyes Approach used instead of endonasal endoscopic surgery if tumor size is large or close to optic nerve or vital arteries

14. it is a minimally invasive procedure, supra-orbital “eyebrow” craniotomy may offer Less pain than open craniotomy Faster recovery than open craniotomy Minimal scarring Mainly used for Rathke’s cleft cysts Skull base tumors Pituitary tumors

15. Retro-Sigmoid “Keyhole” Craniotomy Minimally -invasive surgical procedure A small incision behind the ear Providing access to cerebellum and brainstem  Approach used to reach acoustic neuromas (vestibular schwannomas )

16. Translabyrinthine Craniotomy Incision in scalp behind the ear Mastoid bone and some of the inner ear bone remove Considered for removal of acoustic neuromas Semicircular canals of ear are removed in order to access tumor Removal of semicircular canal reduced risk of facial nerve injury

17. Orbitozygomatic Craniotomy Traditional skull base approach used to target difficult tumors and aneurysms Incision make at scalp behind the hairline bone remove that forms the contour of orbit and cheek

18. Brain tumors that treated through Orbitozygomatic Craniotomy includes Craniopharyngiomas Pituitary tumors   Meningiomas

19. Supratentorial craniotomy Supratentorial craniotomy means the exposure of any part of a cerebral hemisphere over the basal line joining the nasion to the inion .

20. Other types of craniotomies include: Keyhole Craniotomy Surgery is carried out through a small holes Done for lesions that are not immediately just below the brain Minimize collateral damage to surrounding scalp, brain, blood vessels, and nerves.

21. Potential advantages of keyhole brain  Smaller incisions and bony openings (or no incision is performed through the nostrils – endonasal ) Less exposure to normal brain structures No use of brain retraction with less manipulation of the brain itself Less pain and lower need for narcotics Rapid recovery, mobilization, and return to normal activities Discharge from hospital typically within 1 to 2 days post-surgery

22. Stereotactic Craniotomy Uses tiny markers, called fiducials , instead of a head frame MRI or CT scans are taken 3D computer model created Helps to locate problem area that needs surgery and display on computer model

23. Awake Craniotomy Patient can be woken up during surgery Commonly done for epilepsy surgeries lesion is close to a critical area of brain Indications Mass lesion residing motor and language cortex Cortex responsible for other functions Benefits Maximize tumor resection while preserving neurological function.

24. Equipments The following are requirements for being able to perform a craniotomy : 3 –pin skull fixation device

25. High-speed pneumatic cranial drill ( craniotome ) Hudson brace handheld manual drill Cranial plate fixation tray

26. What happen to the Bone flap? In some cases, depending on etiology and indication for the procedure , Bone can be discarded Stored in the abdominal subcutaneous space Cryopreserved under cold storage conditions

27. Craniectomy Bone flap is discarded or not placed back into the skull during same operation It is usually performed after a traumatic brain injury.

28. Decreases intracranial pressure (ICP), Intracranial hypertension (ICHT) Heavy bleeding (also called  haemorrhaging) inside skull INDICATION

29. Cranioplasty Surgical procedure to reconstruct and place the bone flap back into the skull during a second intervention

30. What are the Tests Done Prior to Craniotomy? Tests is required to diagnose the pathology Helps to locate precisely within the skull Routine tests done before any surgery Imaging Tests CT scan (most common) MRI Angiography

31. Routine Tests  which are done before any surgery include: Blood tests like hemoglobin levels, blood group Liver and kidney function tests Blood coagulation test ( Prothromibin time test) Urine tests ECG

32. Consent form and complete paperwork Helps to give medical history Inform about any allergies, medicine going on, previous surgeries What things patient should take care ? Discontinue all NSAIDS( Naproxin , Advil etc) Blood thinners ( coumadin , aspirin, etc) 1 week before surgery Stop smoking, chewing tobacco and drinking alcohol 1 week before surgery and 2 week after surgery

33. What happens during Surgery? 6 main steps during craniotomy Preparing patient Make a skin incision Perform a craniotomy Expose the brain Correct the problem Close the craniotomy

34. Preparing patient No drink & food is allowed past midnight before surgery General anaesthesia administered Head is shaved Head is placed in 3 –pin skull fixation device Lumbar drain to remove CSF fluid

35. Make a skin incision Skin is prepared with antiseptic Skin incision marked Entire incision area may be shaved Either, Hair –sparing technique used

36. Perform a craniotomy Skin and muscle lifted off and folded back One or more small burr holes made with drill Craniotome to cut outline of bone flap Bone flap lifted and dura mater exposed

37. Expose the brain Opening dura with surgical scissors Folds it back to expose brain Retractors placed on brain Gently open a corridor to area needing repair or removal

38. Correct the problem Neurosurgeons use special magnification glasses called loupes Neurosurgeon used variety of small tools to cut open and repair brain tissue Some time computer image guidance system is used Used evoked potential monitoring used to stimulate specific cranial nerves

39. Close the craniotomy Problem removed or repaired Retractors holding the brain are removed Dura is closed with sutures Bone flap is replaced back by titanium screws and plates

40. What are the risks? General complication Bleeding Infection Blood clots Reactions to anesthesia Specific complications Stroke Seizures swelling of brain, which may require a second craniotomy Nerve damage result in muscle paralysis or weakness CSF leak Loss of mental functions Permanent brain damage with associated disabilities No surgery is without risks

41. Summary Craniotomy is a cut that opens the cranium A craniotomy may be small or large depending on the problem. Indication Various neurological diseases injuries or conditions such as brain tumors Hematomas (blood clots) Aneurysms or AVMs Skull fractures Other reasons for a craniotomy may include foreign objects (bullets), swelling of the brain, or infection.

42. References https://www.iowaclinic.com/webres/File/craniotomy.pdf Fernández -de Thomas RJ, De Jesus O. Craniotomy. [Updated 2022 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan- https://mayfieldclinic.com/pe-craniotomy.htm

43. Thank You