Name of the Procedure:

Craniectomy, Trephination, Bone Flap Craniotomy for Excision of Brain Tumor, Supratentorial (Except Meningioma)

Summary

In this procedure, a portion of the skull is removed to gain access to a tumor located above the tentorium in the brain. The tumor, which is not a meningioma, is then excised. The bone flap is either replaced postoperatively or not, depending on the situation.

Purpose

The procedure is aimed at removing brain tumors located in the supratentorial region. This can alleviate symptoms caused by the tumor, improve neurological function, or prevent further spread and complications.

Indications

• Presence of a supratentorial brain tumor (excluding meningiomas)
• Symptoms such as headaches, seizures, neurological deficits, or increased intracranial pressure
• Diagnosis confirmed through imaging and other diagnostic assessments

Preparation

• Fasting typically required 6-8 hours before surgery
• Adjustment of medications as advised by the healthcare provider
• Preoperative imaging studies (MRI or CT scans) to precisely locate the tumor
• Blood tests, ECG, and other assessments to ensure patient’s fitness for surgery

Procedure Description

1. Patient receives general anesthesia.
2. The scalp is shaved and cleaned.
3. A skin incision is made, followed by the removal of a bone flap using specialized tools.
4. The dura mater (outer membrane of the brain) is carefully opened.
5. The tumor is then located and excised using microsurgical techniques.
6. Once the tumor is removed, the dura mater is closed, and the bone flap is replaced or left out as necessary.
7. Finally, the scalp is sutured closed.

Tools used include scalpels, bone saws, retractors, and microsurgical instruments.

Duration

The procedure typically lasts between 4 to 6 hours, depending on the complexity.

Setting

This surgery is performed in a hospital setting, specifically in an operating room equipped for neurosurgical procedures.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians
• Possibly a neurophysiologist for intraoperative monitoring

Risks and Complications

• Infection and bleeding
• Swelling of the brain
• Neurological deficits (temporary or permanent)
• Seizures
• Reaction to anesthesia
• Possibility of tumor recurrence

Benefits

• Removal of the tumor can relieve symptoms and improve quality of life.
• Potentially restores or preserves neurological functions.
• May prevent the progression of neurological damage.

Recovery

• Monitoring in the ICU for the first 24-48 hours post-surgery
• Pain management and antibiotics
• Gradual return to normal activities, typically over 4-6 weeks
• Regular follow-up visits for neurological assessments and imaging

Alternatives

• Stereotactic radiosurgery
• Chemotherapy and radiotherapy
• Observation with regular imaging for slow-growing tumors
• Each alternative has its own risks, benefits, and appropriateness based on the tumor type and patient condition.

Patient Experience

• Patients will be under general anesthesia, so they won't feel anything during the procedure.
• Postoperative pain and discomfort are managed with medications.
• Possible swelling and bruising around the surgical site.
• Gradual improvement in symptoms related to tumor removal.

Pain management will be provided with medications, and comfort measures include ensuring a quiet environment for recovery and monitoring for any complications.