61322 Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy

Name of the Procedure:

Craniectomy or Craniotomy, Decompressive, with or without Duraplasty, for Treatment of Intracranial Hypertension, without Evacuation of Associated Intraparenchymal Hematoma; without Lobectomy.

Summary

A craniectomy or craniotomy is a surgical procedure where part of the skull is removed to relieve pressure on the brain, commonly due to swelling or increased intracranial pressure. Duraplasty, if done, involves repairing the dura mater, a thick membrane that surrounds the brain and spinal cord.

Purpose

• Medical Condition: Intracranial hypertension (increased pressure within the skull).
• Goals: To reduce intracranial pressure, prevent brain damage, and improve patient outcomes by allowing space for the swollen brain tissue.

Indications

• Severe brain swelling due to trauma, stroke, or other medical conditions.
• Symptoms like severe headache, nausea, vomiting, decreased consciousness, or neurological deficits.
• Imaging or clinical assessment indicating high intracranial pressure.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medications, such as blood thinners, may be necessary.
• Preoperative diagnostic tests include MRI or CT scans of the brain, blood tests, and a thorough physical and neurological examination.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A scalp incision is made over the surgical site.
3. Bone Removal: A section of the skull is removed (craniectomy) or temporarily lifted (craniotomy).
4. Brain Relief: The dura mater may be opened, and duraplasty performed if needed.
5. Closure: The surgeon ensures brain tissue is decompressed, replaces or discards the bone flap (in craniotomy cases, it may be replaced later), and closes the incision.
   • Tools: Scalpels, drills, bone saws, retractors, sutures, and sometimes synthetic dural patches.

Duration

The procedure typically lasts between 2 to 4 hours, depending on the complexity and patient condition.

Setting

This procedure is usually performed in a hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians
• Possibly a neurophysiologist (for monitoring brain activity)

Risks and Complications

• Common Risks: Infection, bleeding, brain swelling, seizures.
• Rare Risks: Cerebrospinal fluid leakage, blood clots, stroke, herniation of brain tissue, neurological deficits.
• Management: Intensive monitoring, antibiotics, antifibrinolytic medications, seizure prophylaxis.

Benefits

• Reduced intracranial pressure
• Prevention of further brain damage
• Improved neurological function and survival rates
• Benefits can be realized almost immediately in cases of acute intracranial pressure relief.

Recovery

• Post-Procedure Care: Monitoring in an ICU, pain management, infection prevention.
• Instructions: Gradual reintroduction to regular activities, wound care, follow-up appointments.
• Recovery Time: Several weeks to months, depending on individual patient factors. Restrictions on strenuous activities will be advised.

Alternatives

• Medical Management: High-dose steroids, osmotherapy, barbiturate coma, and hyperventilation.
• Pros and Cons: Medical management is less invasive but may be less effective in severe cases. Surgery offers definitive pressure relief but comes with surgical risks.

Patient Experience

• During the Procedure: Patient is under general anesthesia and won't feel pain or be aware.
• After the Procedure: Some discomfort at the incision site, headaches, and temporary neurological deficits. Pain is managed with medications, and comfort measures include head elevation and rest.