craniotomy/craniectomy

craniotomy

involves opening the skull surgically to gain access to intracranial structures. This procedure is performed to remove a tumor, relieve elevated ICP, evacuate a blood clot, or control hemorrhage. The surgeon cuts the skull to create a bony flap, which can be repositioned after surgery and held in place by periosteal or wire sutures.

craniectomy

permanent, partial removal of skull

parts of a craniotomy

supratentorial (commonly used) infratentorial transsphenoidal

halo sign

when drainage may contain CSF Dextrose stick- tests drainage of glucose, if you get a positive glucose on drainage we do a further test where we drip the drainage on a clear 4 x 4 if you get this sign that is an indicator of cerebral spinal fluid

burr holes

which are circular openings made in the skull by either a hand drill or an automatic craniotome (which has a self-controlled system to stop the drill when the bone is penetrated). may be used in neurosurgical procedures to make a bone flap in the skull, to aspirate a brain abscess, or to evacuate a hematoma.

Supratentorial

Above the tentorium Incision is made above the area to be operated on; usually located behind the hairline. NC: Maintain head of bed elevated at 30 degrees, with neck in neutral alignment. Position patient on either side or back. (Avoid positioning patient on operative side if a large tumor has been removed.)

Infratentorial

Below the tentorium, brainstem Incision is made at the nape of the neck, around the occipital lobe. NC: Maintain neck in straight alignment. Avoid flexion of the neck to prevent possible tearing of the suture line. Position the patient on either side. use log rolling to turn(Check surgeon's preference for positioning of patient.)

post op dressing care

Reinforce sterile dressings as needed Check for excessive drainage, CSF drainage, infection, displacement, drains Halo stain Complain of salty taste, post-nasal drip- make sure this is not cerebral spinal fluid Avoid coughing, sneezing, nose blowing- can cause CSF leakage If leakage- elevate HOB 30 degrees, sterile gauze pads, no cleaning of ears or nose or nasal suctioning Meningitis symptoms

preoperative nursing care

Routine pre-op Head Shaving Shampoo scalp & assess for infections BASELINE v/s and neuro assessment Avoid enemas ---This would create a vagal response Steroids (blood sugar) Foley catheterization Anti-seizure medications - prophylactic

Transsphenoidal

Sella turcica and pituitary region Incision is made beneath the upper lip to gain access into the nasal cavity. NC: Maintain nasal packing in place and reinforce as needed. Instruct patient to avoid blowing the nose. Provide oral care according to institutional procedure. Keep head of bed elevated to promote venous drainage and drainage from the surgical site.

post op nursing care

Vitals signs, neuro checks hourly, > ICP, seizures, hyperthermia Look for signs of Diabetes insipidus, SIADH Meds: stool softeners, corticosteroids, anticonvulsants, mild analgesics Fluids: I&O - 1500 ml qd to < cerebral edema Infratentorial - may be NPO for 24 hours - impaired swallowing and gag reflex Eye care to protect their cornea's Unconscious patient care Supratentorial approach 30-45 degree HOB, neck neutral Back or unaffected side q 2 hours Infratentorial Flat or elevate 20-30 degrees (small pillow) No neck flexion Turn side to side (logrolling as a unit with sheet) Monitor for respiratory distress Conscious patient- q2hr breathe deeply, but no coughing and avoid vigorous suctioning