61314 Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural

Name of the Procedure:

Craniectomy or Craniotomy for Evacuation of Hematoma, Infratentorial; Extradural or Subdural

Summary

A craniectomy or craniotomy for the evacuation of a hematoma involves surgically removing a portion of the skull to access and remove a blood clot located beneath the tentorium of the brain (area at the base of the skull). This can be done for extradural (outside the brain's dura mater) or subdural (below the dura mater and above the brain) hematomas.

Purpose

The procedure addresses the accumulation of blood (hematoma) in areas that put pressure on the brain, potentially leading to brain damage or death if not treated. The goal is to remove the hematoma and relieve pressure on the brain to prevent further injury and improve patient outcomes.

Indications

• Symptoms such as sudden severe headache, loss of consciousness, seizures, and neurological deficits.
• Diagnosed subdural or extradural hematoma, often through imaging studies like CT or MRI scans.
• Traumatic brain injury leading to bleeding within the skull.

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Detailed medical and anesthetic assessments, including blood tests and imaging studies.
• Medications might be adjusted or stopped, especially blood thinners.

Procedure Description

1. Anesthesia: Administered general anesthesia to ensure the patient is unconscious and pain-free.
2. Incision: An incision in the scalp is made where the surgeon plans to remove the skull bone.
3. Craniectomy or Craniotomy: A portion of the skull is removed to access the hematoma.
4. Evacuation: The surgeon carefully removes the blood clot and stops any active bleeding.
5. Closure: The bone flap (if craniotomy) is replaced, the scalp is sutured, and sometimes a drain is placed to prevent fluid accumulation.

Duration

The procedure typically takes 2-4 hours, depending on the complexity and size of the hematoma.

Setting

Performed in a hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Operating room nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Brain swelling or damage
• Seizures
• Stroke
• Adverse reactions to anesthesia
• Long-term neurological deficits

Benefits

• Immediate relief of pressure within the skull
• Prevention of further brain injury or death
• Potential for significant recovery of neurological function

Recovery

• Close monitoring in an Intensive Care Unit (ICU) post-procedure.
• Pain management with medications.
• Gradual increase in activity as directed.
• Follow-up imaging to ensure hematoma resolution.
• Possible physical and occupational therapy for rehabilitation.
• Recovery period can range from weeks to months, depending on severity.

Alternatives

• Non-surgical management: Observation and medication management if hematoma is small and stable.
• Minimally invasive procedures: Aspiration through a small burr hole in some cases.
• Pros: Less invasive options present less immediate risk.
• Cons: May not be effective for large or life-threatening hematomas.

Patient Experience

• Patients will be under general anesthesia and won't feel anything during the procedure.
• Post-procedure pain and discomfort, managed with medications.
• Potential for headaches, fatigue, and need for gradual rehabilitation.
• Emotional and psychological support might be needed due to the serious nature of the condition and procedure.

This markdown text provides a comprehensive overview of craniectomy or craniotomy for the evacuation of an infratentorial hematoma, suitable for patients and healthcare providers alike.