Tuesday, June 7, 2016

NEURO SURGICAL Procedure 3 craniotomy

Craniotomy
Objective
When on burr hole examination or other investigations larger access is required.
   A segment of the skull bone with the overlying skin and muscle is mobilized
   This lays bare a larger area of dura bare
   Larger lesions can be accessed and removed
   Opening of the skull to treat in emergency or electively
   Intracranial aneurysm
   Arteriovenous malformation
   Occluded intracranial vessel
   Tumors near the pituitary
   Cerebrospinal fluid otorrhea or rhinorrhea
   Subdural or epidural hematoma (acute, subacute or chronic)
   Acoustic neuroma
   Hydrocephalus.
Position
   Varies with position of lesion:
     a.  supine
     b.  prone
     c.  sitting.
Anesthesia
Local or general.
Procedure
   1.  Procedure same as for single burr hole.
   2.  Repeated at the mapped out limits of the osteoplastic flap.
   3.  The intervening skull bones cut with a wire saw protecting the underlying dura.
   4.  Dura mater is carefully separated from the skull.
   5.  Bleeding is controlled with electrosurgical forceps, gelentin sponge, and bone wax.
   6.  The dura mater is incised.
   7.  Vessels in the dural margins are coagulated or ligated with hemoclips.
   8.  Dura mater may be tacked up to the pericranium.
   9.  Moist cottonoids are placed as necessary.
10.  A subcortical mass is approached by the most direct route except when this is through a vital region such as a motor or speech area.
11.  When cerebral resection is completed, the wound is irrigated.
12.  Hemostasis is ensured.
13.  The dural flap is closed making the suture line watertight.
14.  The bone flap is wired back.
15.  Burr holes may be covered with silicone rubber buttons, methylmethacrylate or autogenous bone clips.
16.  Scalp is closed, skin clips are removed.
17.  Wound is dressed and the head is wrapped in a turban like gauze bandage.
18.  On completion of procedure suture in layers.
Instruments
   Craniotomy set
   General set

   Microsurgical instruments (e.g. microforceps, scissors, needle holders, curettes, suction tips, bipolar electrosurgical forceps, dissectors, elevators).

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