Name of the Procedure:

Craniectomy or Craniotomy for Evacuation of Hematoma, Supratentorial; Intracerebral

Summary

In layman's terms, a craniotomy or craniectomy is a surgical procedure where part of the skull is temporarily removed to access the brain and remove a blood clot (hematoma) that is located above the brain's tentorium (supratentorial region).

Purpose

This procedure is performed to treat a hematoma in the brain, often resulting from injury, stroke, or other medical conditions that cause bleeding inside the brain. The goal is to reduce pressure on the brain and prevent further damage, improving neurological function and survival chances.

Indications

The procedure is indicated for patients with:

• Severe head injuries leading to intracerebral hematoma
• Symptoms of increased intracranial pressure (e.g., headaches, vomiting, drowsiness)
• Neurological deficits such as weakness, speech difficulties, or loss of consciousness
• Uncontrolled bleeding in the brain detected via imaging studies

Preparation

• Patients may need to fast (no food or drink) for at least 8 hours before the procedure.
• Certain medications might need to be adjusted, especially blood thinners.
• Pre-operative imaging studies like CT or MRI scans.
• Routine blood tests and physical examination.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Positioning: The patient is positioned to provide optimal access to the affected brain area.
3. Incision: A surgical incision is made in the scalp.
4. Bone Removal: A section of the skull (bone flap) is removed to access the brain.
5. Hematoma Evacuation: The hematoma is carefully located and evacuated using suction devices.
6. Hemostasis: Bleeding vessels are cauterized or clipped to prevent further bleeding.
7. Closure: The bone flap is replaced (in a craniotomy) or left out temporarily (in a craniectomy), and the scalp is sutured closed.

Duration

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

Setting

It is performed in a hospital operating room equipped for neurosurgical procedures.

Personnel

• Neurosurgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Infection
• Bleeding or re-bleeding
• Brain swelling
• Seizures
• Blood clots
• Neurological deficits (e.g., weakness or speech difficulties)
• Complications from anesthesia

Benefits

• Reduced intracranial pressure
• Prevention of further brain damage
• Potential improvement in neurological function
• Increased survival rates

Recovery

• Intensive Care Unit (ICU) stay immediately post-surgery
• Monitoring for neurological function and complications
• Pain management
• Gradual physical rehabilitation
• Possible follow-up imaging studies
• Recovery time can vary from weeks to months, with restrictions on activities such as heavy lifting or driving

Alternatives

• Conservative management with medications (e.g., to reduce brain swelling)
• Minimally invasive procedures (e.g., stereotactic aspiration)
• Each alternative has its own risks and benefits, and the choice depends on the specific case details.

Patient Experience

• During the procedure, the patient will be under general anesthesia and unconscious.
• Post-procedure, patients may experience headaches, swelling, and temporary neurological deficits.
• Pain will be managed with medications.
• Gradual improvement in symptoms with appropriate care and rehabilitation.