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Craniotomy
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Craniotomy
ICD-9-CM 01.2
MeSH D003399
eMedicine 1890449
[edit on Wikidata]
A craniotomy is a surgical operation in which a bone flap is temporarily removed

from the skull to access the brain. Craniotomies are often critical operations,
performed on patients who are suffering from brain lesions or traumatic brain
injury (TBI), and can also allow doctors to surgically implant deep brain
stimulators for the treatment of Parkinson's disease, epilepsy, and cerebellar
tremor.
The procedure is also widely used in neuroscience for extracellular recording,
brain imaging, and for neurological manipulations such as electrical stimulation
and chemical titration. The procedures are used for accessing brain tissue that
must be removed, as well.
Craniotomy is distinguished from craniectomy (in which the skull flap is not
immediately replaced, allowing the brain to swell, thus reducing intracranial
pressure) and from trepanation, the creation of a burr hole through the cranium in
to the dura mater.
Contents
 1Procedure
 2Complications
 3See also
 4References
 5External links
Procedure[edit]
Diagram of the elements of a craniotomy.
Human craniotomy is usually performed under general anesthesia but can be

also done with the patient awake using a local anaesthetic; the procedure,
typically, does not involve significant discomfort for the patient. In general, a
craniotomy will be preceded by an MRI scan which provides an image of
the brain that the surgeon uses to plan the precise location for bone removal and
the appropriate angle of access to the relevant brain areas. The amount of skull
that needs to be removed depends on the type of surgery being performed. The
bone flap is mostly removed with the help of a cranial drill and a craniotome, then
replaced using titanium plates and screws or another form of fixation (wire,
suture, etc.) after completion of the surgical procedure. In the event the host
bone does not accept its replacement an artificial piece of skull, often made
of PEEK, is substituted. (The PEEK appliance is routinely modeled by
a CNC machine capable of accepting a high resolution MRI computer file in order
to provide a very close fit, in an effort to minimize fitment issues, and therefore
minimizing the duration of the cranial surgery.)
Complications[edit]
Bacterial meningitis or viral meningitis occurs in about 0.8 to 1.5% of individuals
undergoing craniotomy.[1] Postcraniotomy pain is frequent and moderate to
severe in nature. This pain has been controlled through the use of scalp
infiltrations, nerve scalp blocks, parecoxib, and morphine, morphine being the
most effective in providing analgesia.
According to the Journal of Neurosurgery, Infections in patients undergoing
craniotomy: risk factors associated with post-craniotomy meningitis, their clinical
studies indicated that "the risk for meningitis was independently associated with
perioperative steroid use and ventricular drainage".
Within the 334 procedures that they had conducted from males and females,
their results concluded that traumatic brain injuries were the predominant causes
of bacterial meningitis.
At least 40% of patients became susceptible to at least one infection, creating
more interconnected risk factors along the way. From the Infectious Diseases
Clinic Erasme Hospital, there had been reports of infections initially beginning
from either the time of surgery, skin intrusion, hematogenous seeding, or
retrograde infections.
Cerebrospinal fluid shunt (CSF) associates with the risk of meningitis due to the
following factors: pre-shunt associated infections, post-operative CSF leakage,
lack of experience from the neurosurgeon, premature birth/young age, advanced
age, shunt revisions for dysfunction, and neuroendoscopes.
The way shunts are operated on each patient relies heavily on the cleanliness of
the site. Once bacteria penetrates the area of a CSF, the procedure becomes
more complicated.
The skin is especially necessary to address because it is an external organ.
Scratching the incision site can easily create an infection due to there being no
barrier between the open air and wound.
Aside from scratching, decubitus ulcer and tissues near the shunt site are also
leading pathways for infection susceptibility.[2]
It is also common to give patients seven days of anti-seizure medications post
operatively. Traditionally this has been phenytoin, but now is
increasingly levetiracetam as it has a lower risk of drug-drug interactions.[3][4]
See also[edit]
 Medicine portal
 Decompressive craniectomy
 Trepanning
References[edit]
1. ^ van de Beek D, Drake JM, Tunkel AR (January 2010). "Nosocomial Bacterial
Meningitis". New England Journal of Medicine. 362 (2): 146–
154. doi:10.1056/NEJMra0804573. PMID 20071704. S2CID 20506761.
2. ^ Hansen, Morten S; Brennum, Jannick; Moltke, Finn B.; Dahl, Jørgen B. (December
2011). "Pain treatment after craniotomy: where is the (procedure-specific) evidence? A
qualitative systematic review". European Journal of Anaesthesiology. 28 (12): 821–
829. doi:10.1097/EJA.0b013e32834a0255. PMID 21971206.
3. ^ Szaflarski, J. P; K. S Sangha; C. J Lindsell; L. A Shutter (2010). "Prospective,
randomized, single-blinded comparative trial of intravenous levetiracetam versus phenytoin
for seizure prophylaxis". Neurocritical Care. 12 (2): 165–172. doi:10.1007/s12028-009-9304-
y. PMID 19898966.
4. ^ Temkin, N. R; S. S Dikmen; A. J Wilensky; J. Keihm; S. Chabal; H. R Winn (1990).
"A randomized, double-blind study of phenytoin for the prevention of post-traumatic
seizures". New England Journal of Medicine. 323 (8): 497–
502. doi:10.1056/nejm199008233230801. PMID 2115976.
External links[edit]
Look up craniotomy in
Wiktionary, the free
dictionary.
hide
Tests and procedures involving the central nervous system
Neurosurgery
Craniotomy
ll Decompressive craniectomy
Cranioplasty
n Thalamotomy
thalamus and globus
Thalamic stimulator
pallidus
Pallidotomy
Cerebral shunt
Ventriculostomy
ventricular system
Suboccipital puncture
Intracranial pressure monitoring
cerebrum Psychosurgery
Lobotomy
Bilateral cingulotomy
Multiple subpial transection

Hemispherectomy
Corpus callosotomy
Anterior temporal lobectomy
pituitary gland
Hypophysectomy
Other hippocampus
Amygdalohippocampectomy
Brain biopsy
es Meningeal biopsy
Spinal decompression
Discectomy
al
Intervertebral disc annuloplasty
al
Cordotomy
Rhizotomy
Neuroimaging
Head CT
Cerebral angiography
Pneumoencephalography
Echoencephalography/Transcranial Doppler
ng Brain MRI
Brain PET
Magnetoencephalography
Myelography
Wada test
Microneurography
Electroencephalography
Lumbar puncture
ic
CSF tap test
Polysomnography
Glasgow Coma Scale
es Mini–Mental State Examination
National Institutes of Health Stroke Scale

CHADS2 score
Categories:
 Neurosurgical procedures

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Craniotomy

From Wikipedia, the free encyclopedia

A craniotomy is a surgical operation in which a bone flap is temporarily removed

Diagram of the elements of a craniotomy.

Human craniotomy is usually performed under general anesthesia but can be

Tests and procedures involving the central nervous system

Intracranial pressure monitoring

Multiple subpial transection

Anterior temporal lobectomy

Glasgow Coma Scale

es Mini–Mental State Examination

National Institutes of Health Stroke Scale

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