61526 Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor

Name of the Procedure:

Craniectomy, Bone Flap Craniotomy, Transtemporal (Mastoid) for Excision of Cerebellopontine Angle Tumor

Summary

A craniectomy with a bone flap craniotomy, transtemporal (mastoid) approach, is a surgical procedure designed to remove tumors located in the cerebellopontine angle (CPA) area of the brain. This involves temporarily removing a section of the skull to access and excise the tumor, often through the mastoid bone for optimal exposure.

Purpose

This procedure is primarily performed to remove tumors in the cerebellopontine angle, such as acoustic neuromas (vestibular schwannomas) or meningiomas. The goal is to eliminate the tumor while preserving neurological function and alleviating symptoms caused by the tumor's presence, such as hearing loss, balance issues, or facial nerve dysfunction.

Indications

• Presence of a cerebellopontine angle tumor diagnosed via imaging.
• Symptoms such as hearing loss, tinnitus, dizziness, or facial nerve weakness.
• Rapid tumor growth or significant size increase on follow-up imaging.
• Associated neurological deficits that impair day-to-day living.

Preparation

• Patients may be advised to fast for 8-12 hours prior to surgery.
• Medication adjustments might be necessary, especially anticoagulants.
• Preoperative imaging studies like MRI or CT scans to map the tumor.
• Comprehensive pre-anesthetic assessment and blood tests.

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Positioning: The patient is placed in a position that provides optimal surgical access to the CPA.
3. Incision: An incision is made behind the ear, and the mastoid bone is exposed and drilled to create a pathway.
4. Bone Flap Craniotomy: A section of the skull (bone flap) is temporarily removed to expose the brain.
5. Tumor Excision: Using microsurgical techniques and tools, the tumor is carefully separated from surrounding structures and removed.
6. Closure: The bone flap is replaced and secured, and the incision is closed.

Duration

The procedure typically takes 4-6 hours, depending on the size and complexity of the tumor.

Setting

The surgery is performed in a hospital operating room equipped with specialized neurosurgical instruments.

Personnel

• Neurosurgeon
• Otolaryngologist (ENT specialist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Cerebrospinal fluid leak
• Damage to cranial nerves causing hearing loss, facial weakness, or balance problems
• Stroke
• Blood clots
• Prolonged hospitalization or need for rehabilitation

Benefits

• Relief from symptoms caused by the tumor.
• Improved neurological function and quality of life.
• Potentially curative treatment, depending on tumor nature.

Recovery

• Patients may need to stay in the hospital for several days after surgery.
• Pain medication and antibiotics might be prescribed.
• Follow-up appointments are necessary to monitor recovery and to perform any needed imaging studies.
• Restrictions on physical activities, especially those that could increase intracranial pressure, for several weeks.

Alternatives

• Stereotactic radiosurgery (e.g., Gamma Knife) for smaller tumors.
• Watchful waiting with regular monitoring for asymptomatic or slow-growing tumors.
• Traditional craniotomy approaches depending on tumor location and patient-specific factors.

Patient Experience

• Under general anesthesia, the patient will not feel anything during the procedure.
• Post-operative pain and swelling around the surgical site are common but manageable with medications.
• Gradual improvement in symptoms might be noticed, though complete recovery may take several weeks to months, and some symptoms may persist or take longer to resolve.
• Regular follow-up and supportive care are key to a smooth recovery.