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Brain Surgery

CRANIOTOMY

Overview:
A craniotomy is the surgical removal of a portion of the skull bone in order to expose the brain for the removal of blood (hemorrhage), a tumor, an arteriovenous malformation, relieving pressure on the brain, or draining a brain abscess. In most instances, the skull portion that was removed is placed back at the end of the surgery, however, in certain instances, the bone will not be placed back for situations where increased pressure on the brain is concerned.

A craniotomy requires a hospital stay of 3-7 days, and possibly a rehabilitation facility or unit for several days after your hospital stay. This is all dependent on your condition.

Procedure:
Your head will be shaved and the skin over the surgical site will be cleansed with an antiseptic solution. There are various types of incisions that may be used, depending on the affected area of the brain. An incision may be made from behind the hairline in front of your ear and the nape of your neck, or in another location depending on the location of the problem. If an endoscope is used, the incisions may be smaller. The scalp will be pulled up and clipped to control bleeding while providing access to the brain.

A medical drill may be used to make burr holes in the skull. A special saw may be used to carefully cut the bone. The bone flap will be removed and saved.

The dura mater (the thick outer covering of the brain directly underneath the bone) will be separated from the bone and carefully cut open to expose the brain. Excess fluid will be allowed to flow out of the brain, if needed. Microsurgical instruments, such as a surgical microscope to magnify the area being treated, may be used. This can enable the surgeon a better view of the brain structures and distinguish between abnormal tissue and healthy tissue. Tissue samples may be sent to the lab for testing.

A device, such as a drain or a special type of monitor, may be placed in the brain tissue to measure the pressure inside the skull, or intracranial pressure (ICP). ICP is pressure created by the brain tissue, cerebral spinal fluid (CSF), and blood supply inside the closed skull.

Once the surgery is completed, the surgeon will suture (sew) the layers of tissue together. The bone flap will be reattached using plates, sutures, or wires. If a tumor or an infection is found in the bone, the flap may not be replaced. Also, if decompression (to reduce pressure in the brain) is required, the bone flap may not be replaced. The skin incision (scalp) will be closed with sutures or surgical staples. A sterile bandage/dressing will be applied over the incision.

Post-Op Care:
Once you are home, it is important to keep the incision clean and dry. Your physician will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

You may choose to wear a loose turban or hat over the incision. You should not wear a wig until the incision is completely healed (about 3 to 4 weeks after surgery).

Return to Work/Sports:
You should gradually increase your physical activity as tolerated. It may take several weeks to return to your previous level of energy and strength.

You may be instructed to avoid lifting heavy items for several weeks in order to prevent strain on your surgical incision.

Do not drive until your physician gives you permission.

Concerns:
Notify your physician to report any of the following:

  • fever and/or chills
  • redness, swelling, or bleeding or other drainage from the incision site or face
  • increased pain around the incision site
  • vision changes
  • confusion or excessive sleepiness
  • weakness of your arms or legs
  • speech difficulty
  • difficulty breathing, chest pain, anxiety, or change in mental status
  • green, yellow, or blood-tinged sputum (phlegm)
  • seizure activity

TRANSSPHENOIDAL HYPOPHYSECTOMY

Overview:
A Transsphenoidal Hypophysectomy is a surgical method that is commonly used for the removal of pituitary tumors. This surgical approach allows for a greater exposure of the vital structures which allows for greater accuracy.

Using the sublabial approach, the surgeon through an incision under the upper lip, elevates the lining of the nasal cavity and advances speculum retractors to the sphenoid sinus through the nasal passages. After entering the sella turcica (the area where the pituitary sits in the brain), the tumor is gently removed in the attempt to preserve normal pituitary tissue. A “packing” in inserted in the sphenoid sinus (nasal cavity) with fat harvested from the abdomen and nasal tubes are inserted to assist with nasal breathing. Transsphenoidal hypophysectomy is a well-tolerated surgical procedure, including by older patients who may not be candidates for other treatments. The key benefit is that it does not require craniotomy, which increases patients’ potential risks and hospital stays and recovery times.

The surgery takes about 1-2 hours.

Post-Op Care:
It may take several weeks to fully recover as patients tend to tire easily. The post-operative care should involve lots of rest and avoiding strenuous activity. The nasal fat packing can be removed by the surgeon in 2-3 days.

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