Name of the Procedure:

Craniectomy or Craniotomy, Drainage of Intracranial Abscess; Supratentorial

Summary

A craniectomy or craniotomy with drainage of an intracranial abscess involves removing a portion of the skull to access and drain an infected area in the brain. This procedure is typically performed to remove pus caused by bacteria, reducing pressure and preventing further infection.

Purpose

This procedure is aimed at treating brain abscesses, which could be life-threatening if not managed. The goals include relieving pressure on the brain, removing infected material, reducing symptoms, and preventing further spread of infection.

Indications

• Severe headache
• Fever
• Neurological deficits (e.g., weakness, speech difficulties)
• Seizures
• Altered mental status
• Imaging evidence of an abscess (e.g., CT or MRI scan)
• Failure of conservative management, including antibiotic therapy

Preparation

• Fasting for at least 8 hours before surgery
• Adjustment or discontinuation of certain medications (e.g., blood thinners)
• Blood tests (e.g., CBC, coagulation profile)
• Imaging studies (CT or MRI scans)
• Meeting with anesthesiologist and surgical team

Procedure Description

1. Administration of general anesthesia for the patient to be completely asleep and pain-free.
2. The scalp is shaved and sterilized.
3. An incision is made in the scalp.
4. A portion of the skull is removed (craniotomy) to access the brain.
5. The brain is carefully exposed, and the abscess is located.
6. The abscess is drained using suction, and its cavity is irrigated.
7. A sample may be sent for microbiological analysis.
8. The bone flap is replaced (in case of a craniotomy) or left off temporarily (in case of a craniectomy).
9. The incision is closed with sutures or staples.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The procedure is performed in a hospital, specifically in a neurosurgical operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding or hematoma
• Brain edema (swelling)
• Neurological deficits (e.g., weakness, sensory loss)
• Seizures
• Anesthesia-related risks
• Hydrocephalus (fluid buildup in the brain)
• Recurrent abscess

Benefits

• Resolution of infection
• Reduction of intracranial pressure
• Alleviation of symptoms
• Prevention of further neurological damage Patients may notice improvement in symptoms within a few weeks of recovery.

Recovery

• Post-operative observation in an intensive care unit (ICU)
• Pain management with medications
• Antibiotic therapy
• Gradual return to normal activities over several weeks
• Follow-up appointments with the surgical and infectious disease teams
• Physical or occupational therapy, if necessary

Alternatives

• Extended antibiotic therapy alone
• Minimally invasive aspiration techniques
• Image-guided stereotactic drainage The pros of these alternatives include being less invasive, but they may not be as effective for larger or more complex abscesses.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel anything. Postoperatively, there may be mild to moderate pain at the incision site, headaches, and fatigue. Pain management and comfort measures such as medications and rest are provided to ensure a smoother recovery process.