Craniotomy
Encyclopedia
A craniotomy is a surgical operation
in which a bone flap is temporarily removed from the skull
to access the brain. Craniotomies are often a critical operation performed on patients recording, brain imaging, and for neurological manipulations such as electrical stimulation and chemical titration.
Human craniotomy is usually performed under general anesthesia but can be also done with the patient awake using a local anaesthetic; the procedure generally does not involve significant discomfort for the patient. In general, a craniotomy will be preceded by an MRI
scan which provides a picture 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 to a large extent 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).
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
.
occurs in approximately 0.8 to 1.5% of individuals undergoing craniotomy. Postcraniotomy pain is frequent and moderate-to-severe in nature. This pain has been controlled through the use of: scalp infiltrations, nerve scalp blocks, parexocibs, and morphine
- morphine being the most effective in providing analgelsia.
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 due to it have fewer drug-drug interactions
.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
in which a bone flap is temporarily removed from the skull
Human skull
The human skull is a bony structure, skeleton, that is in the human head and which supports the structures of the face and forms a cavity for the brain.In humans, the adult skull is normally made up of 22 bones...
to access the brain. Craniotomies are often a critical operation performed on patients recording, brain imaging, and for neurological manipulations such as electrical stimulation and chemical titration.
Human craniotomy is usually performed under general anesthesia but can be also done with the patient awake using a local anaesthetic; the procedure generally does not involve significant discomfort for the patient. In general, a craniotomy will be preceded by an MRI
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
scan which provides a picture of the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
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 to a large extent 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).
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
Trepanation
Trepanning, also known as trephination, trephining or making a burr hole, is a surgical intervention in which a hole is drilled or scraped into the human skull, exposing the dura mater in order to treat health problems related to intracranial diseases. It may also refer to any "burr" hole created...
, the creation of a burr hole through the cranium in to the dura mater
Dura mater
The dura mater , or dura, is the outermost of the three layers of the meninges surrounding the brain and spinal cord. It is derived from Mesoderm. The other two meningeal layers are the pia mater and the arachnoid mater. The dura surrounds the brain and the spinal cord and is responsible for...
.
Post-Surgery Complications
Bacterial meningitisBacterial meningitis
Bacterial meningitis refers to meningitis that is caused by bacterial infection.-Signs and Symptoms:*Fever*Seizures*Meningismus*Headache*Vomiting*Photophobia*Altered mental status and coma*Anorexia...
occurs in approximately 0.8 to 1.5% of individuals undergoing craniotomy. Postcraniotomy pain is frequent and moderate-to-severe in nature. This pain has been controlled through the use of: scalp infiltrations, nerve scalp blocks, parexocibs, and morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
- morphine being the most effective in providing analgelsia.
It is also common to give patients seven days of anti-seizure medications post operatively. Traditionally this has been Phenytoin
Phenytoin
Phenytoin sodium is a commonly used antiepileptic. Phenytoin acts to suppress the abnormal brain activity seen in seizure by reducing electrical conductance among brain cells by stabilizing the inactive state of voltage-gated sodium channels...
, but now is increasingly Levetiracetam due to it have fewer drug-drug interactions
.