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