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).
Any questions be sent to drmmkapur@gmail.com
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