Craniotomy is the surgical process to remove a part
of bone from skull to expose to brain. Special tools are used to remove the
section of bone called as bone flap. The bone flap is removed temporarily, and
then replaced after the surgery is performed.
For some procedures, computer and imaging are used
to reach the exact location in brain which is to be treated. The technique
require the use of frame placed onto skull using superficially placed markers
on scalp. When any of the imaging process is used with craniotomy procedure,
called as stereotactic craniotomy.
Endoscopic craniotomy is another type of craniotomy
which involve the insertion of lighted scope with camera in brain through a
small cut in skull.
Aneurysm clipping is a surgical process which may
require craniotomy. The cerebral aneurysm is bulging weakened area in wall of
artery in brain, which results in abnormal widening. Due to the weakened area
in wall, there is a risk of rupture of aneurysm. A metal clip is placed across
the neck of aneurysm, which isolates it from rest of circulatory system by
blocking blood flow, and preventing the rupture.
Craniectomy is similar process in which a part of
skull which is permanently removed or replaced later during second surgery
after the swelling goes down.
Types
of Craniotomy
Extended Bifrontal Craniotomy
It is
a traditional skull base approach used to target difficult tumors toward front
of brain. It involve making a cut in scalp behind hairline and removing the
bone which form the contour of orbits and forehead. The bone is replaced at the
end of surgery.
Minimally Invasive Supra-Orbital "Eyebrow"
Craniotomy
It is
sometimes called as eyebrow craniotomy. It is a procedure which is used to
remove brain tumors. In this procedure, neurosurgeon will make a small cut
within eyebrow to access pituitary tumor. Since it is minimally invasive
procedure, the eyebrow craniotomy can offer:
1.
Minimum scar.
2.
Less pain.
3.
Faster recovery.
Retro-Sigmoid "Keyhole" Craniotomy
It is
sometimes called as keyhole craniotomy. It is a minimally-invasive surgical
procedure done to remove the brain tumors. The process allow the removal of
skull base tumors by a small cut behind ear, which provides the access to
cerebellum and brainstem.
This
can be performed on following types of brain tumors-
1.
Meningiomas.
2.
Spine tumors.
3.
Acoustic neuromas.
4.
Skull base tumors.
Orbitozygomatic Craniotomy
It is
a traditional skull base approach which is used for difficult tumors and
aneurysms. It is used for those lesions which are too complex to remove by
minimally invasive approach. It involves making a cut in scalp behind hairline
and removing the bone which forms the contour of orbit and cheek. The bone is
replaced at end of surgery. The temporary removal of bone helps surgeon to
reach the difficult areas of brain and minimizing the damage to brain.
Translabyrinthine Craniotomy
It is
a procedure which involve making a cut in scalp behind ear, and then remove the
mastoid bone and some inner ear bone. The surgeon will find and remove tumor.
Reason
for surgery
A craniotomy may be done for various reasons,
including
·
Removing blood or blood clots from
leaking blood vessels.
·
Repairing skull fracture.
·
Repairing or clipping of an aneurysm.
·
Relieving pressure within brain by
removing swollen areas of brain which is caused by stroke.
·
Draining brain abscess.
Risks
Risks include:
·
Infection.
·
Blood clots.
·
Bleeding.
·
Blood pressure.
·
Swelling in brain.
·
Seizures.
·
Coma.
·
Paralysis.
·
Memory problem.
Surgery
A craniotomy require three to seven
days stay in hospital. The procedure vary depending on the patient's condition.
An intravenous line will be inserted in arm or hand..To drain urine, a urinary
catheter will be inserted. Head will be shaved and skin over surgical site will
be cleaned with antiseptic solution. Cut will be made according to the affected
area of brain. If the cut is small, then an endoscope is used. The scalp will
be clipped and pulled up to control bleeding while accessing the brain. A
medical drill can be used to make burr hole in skull. Bone flap will be removed
and saved. The excess fluid will be flown out of brain, if needed.
Microsurgical instruments helps surgeon to see better view of brain structure
and differentiate between healthy and unhealthy tissues. A special type of
monitor is placed to check the pressure inside skull. After the surgery is
complete, surgeon will sew the tissues layers together. Bone flap will be
reattached using plates or wires. If tumor is found in bone, flap will not be
replaced. The scalp will be closed with sutures. A sterile bandage will be
applied over the cut. The patient will be under observation for some time,
and then discharged.
-SurgeryXchange
is an online platform for medical second opinions and advisory services
for hospital admission.
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