CRANIOTOMY

Dr UMAR FAROOQ
NEUROSRGERY DEPTT:
SIH
 INTRODCTION
FEW TERMS

CRANECTOMY ( REMOVAL OF BONE )

CRANIOTOMY ( SECRING THE BONE FLAP)
CRANIOSTOMY ( SMALL HOLE WITH DRILL NOT BURR
HOLE)
BURR HOLE ( OPENING WITH BURR AND PERFORATOR)
SCALP ANATOMY
SSkin
CSub cutaneous
tissue
A...Aponeurosis
LLoose areolar
tissue
P.Pericranium
BLOOD SUPPLY OF THE SCALP
supratrochlear artery
Supraorbital artery
Superficial temporal artery
Posterior auricular artery
Occipital artery
SCALPVENOUS DRAINAGE OF
THE
SUPERTROCHLEAR V

SUPRAORBITAL V..FACIAL
V

SUPERFICIAL TEMPORAL
V.retromandibular v.EJV

POSTERIOR AURICULAR
Vretromandibular vEJV

OCCIPITAL V.suboccip v
plexusvertebral or IJV

EMISSARY
VEINS.DIPLOIC V &
INTRACRANIAL VENOUS SINUSES
 CONDITIONS REQRINING CRANIOTOMY

CONGENITAL
ACCQURIED
TRAUMA ( EDH, SDH ,CONTSIONS.ICB)
TUMOR ( ANY BRAIN TUMOR)
INFECTIONS ( BRAIN ABCESS,TUBERCOLUMAS)
VASCULAR (ANEURSYMS, AVM)
PRE OP
MANAGEMENT

3A
Alive or Dead

Ask for help

Action
MANAGEMENT

3R
R1 ABCDE

R2 7B

R3 4P
MANAGEMENT
R1
(Revival)
A Air way

B Breathing

C Circulation

D Deformity / Documentation

E Evaluation
MANAGEMENT
R2
(Review)

Brain

Breathing

Back

Blood

Bladder

Bones

Bowel
MANAGEMENT
R3
(Rehabilitation)

Physiological

Physical

Psychological

Professional
INVESTIGATIONS
X-Rays

CT SCAN

Blood CP

LFTs, RFTs, S/E, Hepatitis Profile

PT, APTT

X-MATCH ARRANGE BLOOD

POST OP
NEURO-OBSERVATION
Airway
Breathing
Blood Pressure
Vomiting
Fits
GCS
Pupils
Focal Deficit
Wound
THE FIRST POST-OPERATIVE
ASSESSMENT
Complete Mental status assessment
Assessed according to GCS
Patients at risk of deterioration require frequent assessment

Complete Circulatory volume assessment

Hands warm or cool, pink or pale
Capillary return- less than 2 seconds or not?
Pulse rate
Pulse volume
Pulse rhythm
Blood pressure
JVP
Urine color and rate of production (0.5 ml/kg/hr)
Drainage from drains, wounds and NG tube
MONITORING
Routine Monitoring
Temperature
Pulse rate
Blood pressure
Respiratory rate
Pain assessment (resting & moving)
Urine output
Oxygen saturation
Additional Monitoring
ECG
Hourly urine volumes
Arterial blood pressure
ABGS
Drainage from wounds
Haematology
Biochemistry
Post-operative monitoring should be continued on daily basis
The monitoring regimen should be reviewed daily
Any change in pts condition should be discussed with seniors
INTRACRANIAL COMPLICATIONS
Poor Recovery
Hematoma
Fits
Brain Swelling / Edema
Pneumocele
CSF Leak
Hydrocephalus
Wound Infection
EXTRACRANIAL COMPLICATIONS

CVS
Respiratory
Renal
Fluid Electrolyte
DVT
Bed Sore
 Wound infection
Causes
Pre-OP
Per-OP
Post-OP

Prevention
Hand washing with soap and water or with alcohol cleansing agents
Early identification and appropriate treatment of infection improves result
Urine and blood cultures should be obtained whenever the is reason to suspect
systemic infection
If the cause of infection is unknown treat with broad spectrum antibiotics
Result from microbiological specimens should be revived regularly and
antibiotics changes as necessary.
A course of antimicrobial treatment should generally be limited to 5-7 days
NUTRITION
Oral intake should be commenced as soon as possible after
surgery.
Nutrition of the pt. should be discussed with the nutritionist
Enteral nutrition is the preferred method of postoperative
nutritional support and should be used if possible
ARTIFICIAL NUTRITIONL TECHNIQUES
Nasogastric feeding
Gastrostomy
Jejunostomy
PARENTERAL NUTRITION
Canulla
Central venous feeding
DISCHARGE & INSTRUCTIONS

Steroids
Antibiotics
Anti-epileptics
Stitches
Histopathology
Radiotherapy
Chemotherapy
Follow up
CONCLUSION
Successful management depend upon the right decision
proper timing, pre-op care and post-op management
We should talk to the pts family according to their mental
level
Post operative management is a triangle which's all ends are
important
Patient

Doctor Nurse