6712 craniotomy

7/28/2019 6712 Craniotomy

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Craniotomy


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Craniotomy craniotomy is a surgical opening of the skull to gain

access to portion of the CNS inside the cranium.

Cases that craniotomy is required:-

Brain tumor resection or removal.

cerebral decompression.

evacuation of hematoma or abscess.

clipping of aneurysm or removal of arteriovenous

malformation.


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Preoperative care* protection of the integrity of the CNS is the major priority of

care for the patient awaiting a craniotomy.

* detailed assessment and documentation of the patientspreoperative neurological status are imperative for accuratepost operative evaluation.

* in pituitary patient, evaluation of endocrine function isnecessary to prevent intraoperative and postoperative

complication.

* routine preoperative screening should be performed( CBC,BUN, Cr, FBS, chest x- ray, ECG, cross match).


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preoperative teaching is important to both patient and familyabout post operative period, which include the followingissues:-

patient should know that all or part of his/her heads hair willbe shaved to do operation, patient should know about facialodema or periorbital ecchymosis, also patients should knowabout the suspected complication such as infection,hemorrhage, anesthesia problems, and also suspectedneurological deficit.

patient undergoing transsphenoidal approach requirespreparation for the sensation associated with nasal pack.


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Postoperative medical management

I- Intracranial hypertension:

Postoperative cerebral edema is expected to peak

in the first 48 to 72 hours. Monitoring of thesurgical site for herniation because of high ICP inthe absence of bone flap.

Treatment include: CSF drainage, patientpositioning by elevation of bed up to 30 degree, andsteroid administration( dexamethasone).


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II- surgical hemorrhage:-

Manifested when there is neurological deficit ordeterioration in the level of consciousness, which need re-exploration of the surgical site.

III- fluid imbalance: Observe for signs of diabetes insipidus( D.I):-

1- polyurea: urine output more that 200 ml per hour.

2- Urine specific of 1.0005or less with elevation of serum

osmolality and decrease in urine osmolality.

Observe for signs of SIADH


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IV- CSF leak:-

Management of CSF leak:- head elevation,

bed rest , suturing at the site of leak if

possible and compressing dressing, taking

sample from leakage for analysis if it is

serous or CSF, or lumbar puncture or

insertion of lumbar subarachnoid drain todrain CSF until dura heal.


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V- deep vein thrombosis:- DVT occur in 29% to 46% of all neurosurgical patient, as

compared with 25% incidence in general surgicalpatients.

Causes include: operation lasted more than 4 hours patient with supratentorial approach. preoperative legs weakness.

long stay postoperative in bed rest.


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Postoperative nursing management

Preserving adequate cerebral perfusion;

1- positioning( head elevation).

2- fluid management .3- vomiting and fever.

Promoting arterial oxygenation


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Providing comfort and emotional support :

control of headache.

administer stool softners and provide bowel

program.

Maintaining surveillance for complication:-

infection.

corneal abrasions.

injury and convulsion.


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Patient education.

Initiating early rehabilitation

6712 craniotomy

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