Name of the Procedure:

Craniectomy or Craniotomy, Decompressive, with or without Duraplasty, for Treatment of Intracranial Hypertension, without Evacuation of Associated Intraparenchymal Hematoma; with Lobectomy

Summary

This surgical procedure involves removing part of the skull (craniectomy or craniotomy) to alleviate severe brain swelling (intracranial hypertension). In some cases, part of the brain lobe is also removed (lobectomy) to further reduce pressure and risk of damage.

Purpose

This procedure addresses severe intracranial hypertension, which is elevated pressure within the skull that can lead to brain damage or death. The goal is to reduce this pressure, prevent further brain injury, and save the patient's life.

Indications

• Severe traumatic brain injury
• Brain swelling due to stroke or hemorrhage
• Conditions leading to uncontrollable intracranial pressure
• Failure of other medical treatments to lower intracranial pressure

Preparation

• Fasting for at least 8 hours before surgery.
• Discontinuation of certain medications as directed by the doctor.
• Preoperative imaging studies (CT scan or MRI) to assess brain condition.
• Blood tests and other relevant diagnostic evaluations.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are unconscious and pain-free.
2. Incision: A surgical incision is made in the scalp.
3. Bone Removal: A section of the skull is removed to access the brain.
4. Duraplasty (if applicable): The tough outer membrane covering the brain (dura mater) may be opened and, if necessary, expanded with a dural graft.
5. Lobectomy (if applicable): A portion of the brain lobe is carefully removed to alleviate pressure.
6. Closure: The dura mater (and graft, if used) is closed, and the scalp incision is sutured.
7. Monitoring: The removed bone flap may not be replaced immediately but rather stored for potential later use. The patient is closely monitored in the intensive care unit (ICU).

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the case.

Setting

This procedure is performed in a hospital operating room, typically followed by a stay in the ICU.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians
• Intensive care unit staff

Risks and Complications

• Infection
• Bleeding
• Swelling
• Brain damage
• Seizures
• Cerebrospinal fluid leakage
• Scarring or disfigurement
• Need for additional surgeries

Benefits

• Reduction in intracranial pressure
• Prevention of brain herniation and further brain damage
• Potentially life-saving intervention
• Improvement in neurological function over time

Recovery

• ICU stay for close monitoring immediately after surgery.
• Gradual transfer to a regular hospital room as condition stabilizes.
• Rehabilitation therapy may be required.
• Follow-up appointments with the neurosurgeon.
• Recovery time can vary from weeks to months, depending on the patient's overall condition and response to treatment.

Alternatives

• Medical management with medications and monitoring.
• Less invasive surgeries if appropriate.
• Hyperosmolar therapy to reduce intracranial pressure.
• Pros and cons of alternatives vary based on how effective they are in controlling intracranial pressure and the urgency of the situation.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Postoperatively, they may experience pain, headache, and swelling, which will be managed with pain medications and other supportive measures. Rehabilitation and close follow-up care are critical to ensure optimal recovery and functional improvement.