Craniotomy for Hematoma
At times, a craniotomy, or temporary removal of a part of the skull, must be performed to treat a hematoma, (intracranial bleeding, or bleeding inside the brain). The cause of such hemorrhage is usually a traumatic head injury from a fall, a vehicular accident or a sports injury. Such incidents are more common in the elderly or in anyone who is taking anticoagulant medication. Because a hematoma may cause unconsciousness and even death, the craniotomy is often a lifesaving operation.
The Craniotomy Procedure
A craniotomy may be performed under general or local anesthesia. The latter is required when the patient's participation is necessary to check for brain function during the procedure. At the beginning of the operation, an incision is made in the scalp to allow access to the treatment site, either with a special saw or a medical drill (for keyhole craniotomies).
The scalp is pulled up and clipped to control bleeding while providing access to the brain. The dura mater, or thick outer membrane covering the brain, is separated from the bone and carefully cut apart to allow any excess fluid that has accumulated to drain. At times, microsurgical instruments may be used under magnification to enable the surgeon to visualize the area more precisely. Once the procedure has been completed, the tissue that has been cut is sutured and normally the bone flap is reattached.
Recovery from a Craniotomy Procedure
The postsurgical craniotomy patient spends some time in intensive care (ICU) until vital signs are stable and the patient is alert. Once out of ICU, the patient will remain hospitalized for several days and oxygen will be administered. Respiratory therapy will be given to make sure the patient's lungs re-expand and that the patient doesn't develop pneumonia.
During recovery in the hospital, the patient will also wear sequential compression devices (SCDs) to prevent the formation of blood clots in the legs and will periodically be administered neurological and cognitive testing to check brain function. While some swelling of the head is expected following the craniotomy procedure, the patient's head is kept elevated to keep such swelling to a minimum. Many patients who have undergone a craniotomy spend several days in a rehabilitation facility after the procedure.
A craniectomy is a surgical procedure performed when the portion of the skull removed during brain surgery is not replaced immediately. Reasons for the neurosurgeon to perform a craniectomy include: creating room the brain swelling after traumatic injury, removing infected portions of the skull, or removing portions of the skull where traumatic injury has resulted in multiple fragments. The procedure is always performed as a lifesaving measure.
The Craniectomy Procedure
During a craniectomy, once the patient is anesthetized, the skin on the scalp and the underlying tissues are cut and clipped out of the way. The primary surgical tools employed in the surgery are a drill, used to make holes in the skull, and a saw to cut and remove a bone flap.
After the craniectomy, the bone flap is normally stored in a sterile environment until proper healing has taken place so that the reparative operation can be performed. Usually, bone flaps are replaced 6 weeks to 3 months after a craniectomy. At times, if the damage to the patient's skull is too extensive, or there is infection present, it may be necessary to use synthetic materials, instead of the patient's own bone, to make the repair.
Protecting the Craniectomy Site
It is necessary that the surgical site be carefully protected. In many cases, patients who have had a craniectomy are sent home from the hospital with a protective helmet. For at least 6 weeks, the patient should refrain from any activity that may result in a hit to the head or a fall.
Risks of a Craniectomy
While very often highly effective, brain surgery carries inherent risk. In addition to the risks of any surgical procedure, such as breathing difficulty, excessive bleeding, blood clots and adverse reactions to anesthesia or medication, the major risks of a craniectomy are bleeding in the brain and infection, either of which may lead to further brain damage. It may take at least a year for a patient to fully recover from a craniectomy and rehabilitative treatment may be necessary.
There are several signs that signal the need for urgent medical attention following a craniectomy. These include:
- Altered behavior, mood or mental ability
- Repeated vomiting
- Drainage or swelling at the surgical site
- Seizural activity
Any headache unrelieved by over-the-counter medication is also cause for concern.