61304 Craniectomy or craniotomy, exploratory; supratentorial

Name of the Procedure:

Craniectomy or Craniotomy, Exploratory; Supratentorial

Summary

A craniectomy or craniotomy, exploratory, supratentorial, involves removing part of the skull to access the brain for exploratory purposes. Supratentorial refers to the area above the tentorium cerebelli, a membrane separating the cerebellum from the cerebrum. This procedure helps diagnose and treat various brain conditions.

Purpose

The procedure is used to:

• Address brain tumors, blood clots, aneurysms, or head injuries.
• Relieve increased intracranial pressure.
• Obtain a biopsy for abnormal brain tissues.
• Clear up infections or abscesses in the brain.

Indications

• Persistent headaches or seizures.
• Neurological deficits like muscle weakness or speech difficulties.
• Imaging results showing brain abnormalities (e.g., tumors, bleeding).
• Symptoms of increased intracranial pressure.

Preparation

• Fasting for 8 to 12 hours before the procedure.
• Adjusting or stopping certain medications (e.g., blood thinners).
• Pre-procedure imaging studies such as MRI or CT scans.
• Blood tests to check overall health and readiness for surgery.

Procedure Description

1. The patient receives general anesthesia.
2. The head is shaved and sterilized.
3. An incision is made in the scalp.
4. A portion of the skull is removed to access the brain.
5. The surgeon examines the brain tissue.
6. Biopsies or other necessary treatments (e.g., removal of tumors or clots) are performed.
7. The skull piece is replaced (in craniotomy) or not replaced (in craniectomy).
8. The incision is closed with sutures or staples.

Tools and Equipment: Surgical drills, scalpels, forceps, and suction devices. Anesthesia: General anesthesia is used.

Duration

The procedure typically lasts between 2 to 6 hours, depending on the complexity.

Setting

Performed in a hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding or blood clots
• Swelling of the brain
• Seizures
• Neurological deficits
• Reactions to anesthesia

Benefits

• Diagnosis and treatment of brain conditions.
• Relief from symptoms like headaches or seizures.
• Improved neurological function, depending on the underlying issue.
• Reduction in intracranial pressure.

Recovery

• Initial recovery in the intensive care unit (ICU).
• Hospital stay for 3 to 7 days on average.
• Pain management with medications.
• Instructions on wound care and activity restrictions.
• Follow-up appointments for monitoring and sutures/staples removal.
• Gradual return to normal activities over several weeks to months.

Alternatives

• Medication management for less severe cases.
• Minimally invasive procedures like stereotactic biopsy.
• Stereotactic radiosurgery for certain types of brain tumors or abnormalities.
• Pros and cons: Alternative treatments may be less invasive with quicker recoveries but may not be suitable for all conditions.

Patient Experience

• Patients typically wake up with some pain and swelling at the surgical site.
• Sensations of headache or dizziness post-procedure.
• Pain is managed with prescribed medications.
• Some restrictions on activities and advice on rest to promote healing.