KRANIOTOMI DEKOMPRESI

DEFINISI
Trepanasi/ kraniotomi adalah suatu tindakan
membuka tulang kepala yang bertujuan
mencapai otak untuk tindakan pembedahan
definitif.

MODUL BEDAH SARAF. TREPANASI/ KRANIOTOMI PADA EPIDURAL HEMATOMA DAN SUBDURAL HEMATOMA (ICOPIM: 5-011
ANATOMI
 INDIKASI
TRAUMA
Penurunan kesadaran tiba-tiba di depan mata
Adanya tanda herniasi/ lateralisasi
Adanya cedera sistemik yang memerlukan operasi
emergensi, dimana CT Scan Kepala tidak bisa
dilakukan.
NON-TRAUMA - TTIK/edema serebri
stroke hemoragik
perdarahan post op aneurisma
infark serebri
Condition Management
Subdural H ematoma
>10 mm thick or >5 mm midline shift Surgical evacuation

<10 mm thick and <5 mm midline shift, and

GCS score <9 with 2 point decrease, and/or Surgical evacuation
pupillary dysfunction, and/or ICP >20 mm Hg
GCS score <9 ICP monitoring
Epidural Hematoma
>30 mL volume, regardless of GCS score Surgical evacuation
<30 mL volume, and
Conservative management with
<15 mm thickness, and
intensive monitoring and serial
<5 mm midline shift, and
imaging
GCS score >8 without focal neurological deficit
Intraparenchymal H ematoma
Progressive neurological deterioration referable to lesion, medically
Surgical evacuation
refractory intracranial hypertension, or mass effect on CT
Any lesion >50 mL Surgical evacuation
Frontal or temporal contusions >20 mL, and
GCS score = 6-8, and
Surgical evacuation
5 mm midline shift, and/or
cisternal compression on CT
No evidence of neurological compromise, and Conservative management with
controlled ICP, and intensive monitoring and serial
no significant signs of mass effect on CT imaging
 KONTRAINDIKASI
Kondisi Umum buruk
bilaterally fixed and dilated pupils, Glasgow
Coma Scale (GCS) score of 3, brainstem injury,
and central herniation are poor candidates for
DC because these findings are known to be
associated with poor outcome.
PERSIAPAN OPERASI
 TEKNIK OPERASI
POSITIONING
WASHING
MARKERING
DESINFEKSI
OPERASI
Placement of exploratory bur holes should
begin in the temporal fossa, ipsilateral to the
suspected lesion. The patient is positioned in a
subdural head holder to expose both sides of
the scalp.
the extent of the incision and underlying bone
resection for decompressive surgery.
Note that the temporal bone must be resected
down to the level of the middle fossa floor.
A, Extent of bony resection necessary for unilateral decompression. Temporal
craniectomy must extend to the level of the middle fossa floor to avoid strangulation of
the temporal lobe.
B, Extent of bony resection necessary for bifrontal decompression, extending across
orbital rims and down to the base of the temporal fossa bilaterally.
C, Three-dimensional view of skull after unilateral decompression.
A, Illustration of curvilinear dural incision, beginning over the temporal lobe. B,
Illustration after durotomy, with incisions in the perimeter of the exposure for additional
relaxation. C, Illustration of dural closure that incorporates a generous dural patch to
allow outward herniation of the brain. D, Example of an edematous hemisphere after
duraplasty, with subtemporalis barrier in place. Note that the barrier is nonincorporating
and large enough to separate the majority of the large temporalis muscle from the
underlying native dura and patch graft.
 KOMPLIKASI
Perdarahan
Infeksi
 PROGNOSIS
Tergantung beratnya cedera otak
 MONITORING PASCA OP &
FOLLOW-UP
Monitor kondisi umum dan neurologis pasien
dilakukan seperti biasanya. Jahitan dibuka
pada hari ke 5-7. Tindakan pemasangan
fragmen tulang atau kranioplasti dianjurkan
dilakukan setelah 6-8 minggu kemudian.
CT scan kontrol diperlukan apabila post
operasi kesadaran tidak membaik dan untuk
menilai apakah masih terjadi hematom
lainnya yang timbul kemudian