Cranial Surgery

AV malformation: cause

congenital tangle of arteries and veins, frequently in middle cerebral artery

aneurysm repair: cause

dilation of weak area in arterial wall, usually near anterior portion of circle of willis

aneurysm repair: surgical procedure

dissection and clipping or coiling of aneurysm

craniectomy: describe, use

excision into cranium to cut away bone flap

AV malformation: surgical procedure

excision of malformation

brain tumors: surgical procedures

excision or partial resection of tumor

post-op: pts who should be at 10-15 degree elevation

incision over anterior or middle fossa

Hydrocephalus: surgical procedure

placement of ventriculoatrial or ventriculopertoneal shunt

post-op: primary goal

prevention of increased LOC

post-op: drugs to avoid

promethazine (phenergan) - can increase somnolence, which impairs neuro exam

intracranial bleeding: cause

rupture of cerebral vessels bc of trauma or stroke

intracranial bleeding: surgical procedure

surgical evacuation through burr holes or craniotomy

post-op: teaching if receiving radiation

use sunblock and head covering when exposed to sun

stereotactic procedure: describe, use

1) after CT and/or MRI, computer aided apparatus targets area of brain. under general or local anesthesia, dr drills burr hole or creates bone flat for entry site and introduces probe 2) removal of small brain tumors/abscesses, drainage of hematomas, ablative procedures for extrapyramidal disease, repair of arteriovenous malformation, biopsies

Shunt procedure: describe, use

1) alternate pathway to redirect CSF from one area to another using a tube or implanted device 2) ventricular shunt, Ommaya reservoir

cranioplasty: describe, use

1) artificial material used to replace damaged or lost bone 2) repair of cranial defect resulting from trauma, malformation or previous surgical procedure

indications

1) brain tumor 2) CNS infection 3) vascular abnormalities 4) craniocerebral trauma 5) seizure disorder 6) intractable pain

brain tumors: S&S

1) change in LOC 2) pupillary changes 3) sensory or motor deficit 4) papilledema 5) seizures 6) personality changes

Types

1) craniotomy 2) sterotactic radiosurgery 3) burr hole 4) craniectomy 5) shunt procedure

skull fracture: surgical procedure

1) debridement of fragments and necrotic tissue 2) elevation and realignment of bone fragments

post-op: common causes of pain

1) edema 2) incision site

Intracranial infection: surgical procedure

1) excision 2) drainage of abscess

stereotactic procedure: how radiation is delivered: tool, course, side effects

1) gamma knife w high dose of cobalt, surgical lasers w CO2, Argon or neodynium (less damage to surrounding tissue) 2) single tx lasting a few hours or multiple sessions 3) fatigue, headache, nasuea

pre-op: teaching

1) general info about operation and post op expectations 2) explain hair will be shaved in the OR after anesthesia 3) pt will be in ICU or special care unit post-op

skull fracture: S&S

1) headache 2) CSF leak 3) cranial nerve deficit

AV malformation: S&S

1) headache 2) intracranial hemorrhage 3) seizures 4) mental deterioration

aneurysm repair: S&S: before rupture

1) headache 2) lethargy 3) visual disturbance

intracranial bleeding: S&S: subdural

1) headache 2) seizures 3) pupillary changes

Hydrocephalus: S&S: later

1) memory impairment 2) urinary incontinence 3) increased tendon reflexes

Hydrocephalus: S&S: early

1) mental changes 2) disturbances in gait

intracranial bleeding: S&S: epidural

1) momentary unconsciousness 2) lucid period, then rapid deterioration

post-op: assessments

1) neuro status 2) F&E levels, serum osmolality for Na changes, onset of diabetes insipidus, hypovolemia

Burr hole: describe, use

1) opening into cranium w a drill 2) used to remove localized fluid and blood beneath dura

Hydrocephalus: cause

1) overproduction of CSF 2) obstruction to flow 3) defective reabsorption

stereotactic procedure: advantage, how different from normal surgery

1) reduction in damage to surrounding area 2) uses precisely focused radiation to destroy tumor cells/abnormal growths 3) computers make 3D image of brain, which are used to guide focused radiation while pt's head is held still in stereotactic frame

goals

1) return to normal consciousness 2) achieve control of pain, nausea, discomfort 3) maximize neuromuscular functioning 4) be rehabilitated to maximum ability

Intracranial infection: S&S: later

1) seizures 2) hemiplegia 3) speech disturbances 4) ocular disturbances 5) decreased LOC

Craniotomy: describe, use, where pts are cared for

1) set of burr holes drilled, saw used to connect holes and remove bone flap, which is later wired or sutured back. Drains may be placed to remove fluid and blood. 2) remove a lesion, repair damaged area, drain blood, relieve increased ICP 3) ICU

Intracranial infection: S&S: early

1) stiff neck 2) headache 3) fever 4) weakness 5) seizures

aneurysm repair: S&S: after rupture

1) violent headache 2) decreased LOC 3) visual disturbances 4) motor deficit