Intracranialsurgery

INTRACRANIAL SURGERY
Prepared By
Jeselo Ouano Gorme, RN, MN
INTRODUCTION
There are numerous types of brain surgery. The type used is based on the area of the brain
and the condition being treated.
Brain surgery is a critical and complicated process. The type of brain surgery done depends
highly on the condition being treated.
DEFINITION
Intracranial surgery refers to various medical procedures that involve repairing

structural problems in the brain.
TYPES
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone
flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or
fluid from an infection, remove abnormal brain tissue, relieve IICP, and evacuate a blood
clot.
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling
brain room to expand without being squeezed. It is performed on victims of traumatic brain
injury, stroke and other conditions associated with raised intracranial pressure.
Pls see video: https://www.youtube.com/watch?v=sEqkejfG9Ys&has_verified=1
TYPES
Burr Holes
circular openings made in the skull by either a hand or an automatic craniotome.
Purpose: to determine the presence of cerebral swelling and injury, determine the size and
portion of the ventricles, evacuate intracranial hematoma or abscess and allowing access to
the ventricles for ventriculography or shunting procedures.
Cranioplasty
repair of a cranial defect using a plastic or metal plate.
ETIOLOGY
Abnormal blood vessels Nerve damage or nerve

Aneurysm irritation
Bleeding Parkinson’s disease
Blood clots Pressure after head injury
Damage to the protective Skull fracture

tissue called the “dura” Stroke
Epilepsy Brain tumors
Abscesses Fluid building up in the brain
MANAGEMENT
PREOPERATIVE MANAGEMENT
1.Diagnostic findings, surgical procedure, and expectations are reviewed with the patient.
2.Presurgical shampoo with an antimicrobial agent may be ordered. Skull preparation is

performed in the operating room.
3.Depending on primary diagnosis, corticosteroids may be ordered preoperatively to reduce

cerebral edema.
4.Depending on the type and location of lesion, anticonvulsants may be ordered to reduce risk of
seizures.
5. The patient is prepared for the use of intraoperative antibiotics to reduce risk of infection.
Urinary catheterization is performed to assess urinary volume during preoperative period.
If cerebral edema develops, intraoperative or postoperative osmotic diuretic -mannitol or

corticosteroids may be ordered for its treatment.
Neurologic assessment is performed to evaluate and record the patient’s neurologic baseline
and vital signs for postoperative comparison.
Family and patient are made aware of the immediate postoperative care and where the
physician will contact the family after surgery.
Supportive care is given, as needed, for neurologic deficits.

Postoperative Management
• Respiratory status is assessed by monitoring rate, depth, and pattern of respirations.A

patent airway is maintained.
• Vital signs and neurologic status are monitored using GCS
• Arterial and central venous pressure (CVP) are monitored.
• Pharmacologic agents may be prescribed to control increased ICP. Mannitol is given
• Incisional and headache pain may be controlled with mild analgesic (codeine and
acetaminophen)
• Position head of bed at 15 to 30 degrees, or per clinical status of the patient, to promote
venous drainage.
Turn side-to-side every 2 hours; positioning restrictions will be ordered by the physician
(craniectomy patients should not he turned on the side of the cranial defect).
Oral fluids are provided after swallow reflex and bowel sounds have returned. Intake and
Output are monitored.
Speech therapy may be ordered for bedside swallow study or radiographic swallow
study.
Signs of infection are monitored by checking craniotomy site, ventricular drainage, nuchal
rigidity, or presence of CSF (fluid collection at surgical site).
NURSING DIAGNOSES
lneffective cerebral tissue perfusion related to increased ICF

Risk for Aspiration related to decreased swallow reflex and postoperative positioning
Risk for Infection related to invasive procedure
Acute Pain related to surgical wound
Constipation related to use of opioids and immobility
NURSING INTERVENTIONS
Maintaining ICP Within Normal Range
1. Closely monitor LOC, vital signs, pupillary response and ICP, if indicated. Notify health
care provider if ICP is greater than 20 mm Hg or CPP is less than 60 mm Hg for more than
15 min.
2. Teach the patient to avoid activities that can raise ICP, such as excessive flexion or rotation
of the head and Valsalva maneuver (coughing, straining with defecation).
3. Administer medications as prescribed, to reduce ICP.
4.Eliminate noxious tactile stimuli, such as suctioning, prolonged physical assessment,
turning, and ROM exercises (based on patient response).
Preventing Aspiration
1. Offer fluids only when the patient is alert and swallow reflexes have returned.
2. Have suction equipment available at bedside. Suction only if indicated.
3. Pretreat with sedation or endotracheal lidocaine to prevent elevation of ICP.
4. Elevate head of bed to maximum of order, or per clinical status, and patient comfort.
Preventing Nosocomial Infections
1. Use sterile technique for dressing changes, catheter care, and ventricular drain
management.
2 Be aware of patients at higher risk of infection-those undergoing lengthy operations.
3Assess surgical site for redness, tenderness, and drainage.
4Watch for leakage of CSF, which increases the danger of meningitis.

Relieving Pain
1. Elevate head of bed as per protocol to relieve headache. .
2. Pain management.
3. Darken room if patient is photophobic.
Avoiding Constipation
1. Encourage fluids when patient is able to manage liquids.
2. Ambulate as soon as possible.
3. Change to non-opioid agents for pain control as soon as possible.
4. Avoid Valsalva’ like maneuvers.
5. Use stool softeners and laxatives, as ordered.
Expected Outcomes
Decreased ICP maintained greater than 70 mm Hg

Gag reflex present; breath sounds clear
Afebrile without signs of infection
Verbalizes decreased pain
Passed soft stool

Intracranialsurgery

Uploaded by

Copyright:

Available Formats

Intracranialsurgery

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Intracranialsurgery

Uploaded by

Copyright:

Available Formats

INTRACRANIAL SURGERY

Intracranial surgery refers to various medical procedures that involve repairing

Abnormal blood vessels Nerve damage or nerve

Bleeding Parkinson’s disease

Blood clots Pressure after head injury

Damage to the protective Skull fracture

2.Presurgical shampoo with an antimicrobial agent may be ordered. Skull preparation is

3.Depending on primary diagnosis, corticosteroids may be ordered preoperatively to reduce

If cerebral edema develops, intraoperative or postoperative osmotic diuretic -mannitol or

Supportive care is given, as needed, for neurologic deficits.

• Respiratory status is assessed by monitoring rate, depth, and pattern of respirations.A

lneffective cerebral tissue perfusion related to increased ICF

Maintaining ICP Within Normal Range

2 Be aware of patients at higher risk of infection-those undergoing lengthy operations.

3Assess surgical site for redness, tenderness, and drainage.

4Watch for leakage of CSF, which increases the danger of meningitis.

Decreased ICP maintained greater than 70 mm Hg

You might also like