Craniectomy for Stereotactic Procedures

How and why is a stereotactic frame used?

A stereotactic frame is a semicircular device that is fastened around the patient's head to keep it in place during surgery; it supports the posterior and anterior sides of the head as the patient lies on his or her back.

What are some equipment, instruments, and supplies unique to this procedure?

A stereotactic system, stereotactic frame, computer equipment with monitor, and Anspach or Midas Rex power instruments with attachments, or cranial perforator and craniotome.

What is the purpose of a Craniectomy?

Allows for the precise localization of subcortical targets without creating large scalp and bone flaps.

What is the skin prep used?

The area around the incision site is shaved and hair is saved for the patient; after the initial prep with iodophor scrub, the surgeon may paint with alcohol and/or iodophor paint.

What is the wound classification?

Class 1: Clean

What can be treated using stereotactic techniques?

Intracranial masses (tumor, hematoma, abscess) and vascular malformations (arteriovenous malformations).

What diagnostic procedures are used?

MRI and CT scans

What anesthesia is used?

Monitored anesthesia care; general

What is the immediate postoperative care?

Patient is transported to PACU

What is the prognosis for no complications?

The patient will remain in the hospital for 2 to 3 days; the prognosis depends on the outcome of the procedure.

Definition of a Craniectomy:

The permanent removal of a section of the cranium using a burr hole to gain access to underlying structures.

What are fiducials used for?

They are placed on bony landmarks or points around the skull before a preoperative MRI or CT scan and are left in place for the operating room.

What are MRI and CT scans used for in a Craniectomy?

To map intracranial lesions with pinpoint precision.

What are stereotactic procedures?

Used in conjunction with CT, it allows a probe to be guided to a specific location within the brain with minimal damage to normal neural tissue.

What is the prognosis for complications?

Wound infection, meningitis, neurological deficits related to the pathological condition, intraoperative damage to vital structures, subdural or epidural hematoma, or intracerebral hemorrhage.