Name of the Procedure:

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

Summary

A craniectomy or craniotomy is a surgical procedure in which part of the skull is removed to access the brain and remove a buildup of blood (hematoma) that lies above the brain's tentorium membrane. This can be performed for extradural (epidural) or subdural hematomas to prevent brain damage.

Purpose

This procedure addresses hematomas, which are collections of blood that can compress the brain tissue. The goal is to relieve pressure, prevent further brain injury, and improve neurological function.

Indications

• Severe head trauma
• Symptoms such as severe headache, vomiting, confusion, and loss of consciousness
• Brain imaging showing a significant hematoma
• Rapid neurological deterioration
• Increased intracranial pressure

Preparation

• Patients are usually instructed to fast for 8 hours before surgery.
• Adjustment or discontinuation of certain medications, particularly blood thinners.
• Pre-operative diagnostic tests, including CT scans or MRI, blood tests, and possibly an electrocardiogram (EKG).

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgical area is prepared and sterilized.
3. An incision is made in the scalp, and a portion of the skull (bone flap) is removed to access the brain.
4. The dura mater (outer brain membrane) is carefully opened.
5. The hematoma is located and evacuated using suction and irrigation devices.
6. After the hematoma is removed, the dura mater is closed.
7. The bone flap is replaced (craniotomy) or left off (craniectomy) if swelling is severe.
8. The scalp is sutured, and a sterile dressing is applied.

Duration

Typically, the procedure lasts between 2 to 4 hours, depending on the complexity of the case.

Setting

Performed in a hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurse
• Scrub tech

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Swelling
• Brain injury or stroke
• Seizures
• Complications from anesthesia

Benefits

• Relief of intracranial pressure
• Prevention of brain damage
• Improvement of neurological function
• Reduced risk of long-term disability

Recovery

• Intensive care monitoring immediately post-surgery.
• Pain management with medications.
• Gradual return to normal activities over several weeks to months.
• Rehabilitation services may be needed (physical, occupational, speech therapy).
• Follow-up appointments to monitor recovery and brain imaging.

Alternatives

• Conservative management with medication if the hematoma is small and stable.
• Minimally invasive procedures such as burr hole drainage for specific cases.
• Each alternative has its risks and benefits, often less effective for large or rapidly worsening hematomas.

Patient Experience

• Significant post-operative pain which can be managed with analgesics.
• Potential for temporary or long-term neurological deficits.
• Initial ICU stay followed by transfer to a regular hospital room.
• Rehabilitation efforts to regain full function.
• Emotional support and counseling may be beneficial to cope with recovery challenges.