Name of the Procedure:

Craniectomy, Trephination, Bone Flap Craniotomy for Excision of Brain Abscess, Supratentorial

Summary

This surgical procedure involves removing a section of the skull to provide access to the brain for the purpose of excising a brain abscess located above the tentorium (the membrane separating the cerebrum from the cerebellum). The bone flap is temporarily removed and replaced after the abscess is removed.

Purpose

The primary purpose of this procedure is to address a brain abscess, which is a collection of pus caused by an infection. The goals are to remove the abscess to reduce intracranial pressure, prevent the spread of infection, and alleviate symptoms such as severe headaches, fever, seizures, and neurological deficits.

Indications

• Presence of a brain abscess confirmed by imaging studies (CT or MRI scan)
• Symptoms such as severe headaches, fever, nausea, vomiting, neurological deficits (e.g., weakness, speech difficulties), or seizures that suggest increased intracranial pressure or infection
• Failure of antibiotic treatment to sufficiently reduce the abscess

Preparation

• Patients are typically required to fast (no food or drink) for about 8 hours before the procedure.
• Blood tests, imaging studies (CT or MRI), and a thorough medical history and physical examination are necessary.
• Certain medications may need to be adjusted or stopped prior to surgery, particularly anticoagulants or antiplatelet drugs.
• The scalp area may be shaved and cleaned to reduce infection risk.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free during the procedure.
2. Incision and Craniectomy: A scalp incision is made over the area of the abscess. Then, a craniotomy is performed, where a piece of the skull (bone flap) is removed using precise surgical instruments.
3. Excision of Abscess: The surgeon accesses the brain tissue, locates the abscess, and carefully removes it, often using suction and irrigation to ensure all infected material is excised.
4. Closing: The bone flap is replaced and secured with small plates and screws. The scalp incision is then sutured closed.
5. Post-Operation: The patient is transferred to a recovery area and closely monitored.

Duration

The procedure typically lasts between 3 to 6 hours, depending on the complexity and the patient's condition.

Setting

This procedure is performed in a hospital operating room, with facilities for neurosurgery.

Personnel

• Neurosurgeon (primary operator)
• Surgical assistants
• Anesthesiologist
• Operating room nurses and technicians
• Radiology technician for intraoperative imaging, if needed

Risks and Complications

• Common risks: Infection, bleeding, swelling at the surgical site
• Rare risks: Seizures, stroke, brain damage, complications related to anesthesia, cerebrospinal fluid (CSF) leak
• Management includes antibiotics for infection, medications for pain and seizures, and close monitoring in the ICU.

Benefits

• Relief from symptoms associated with the brain abscess
• Prevention of further neurological damage
• Reduced risk of the infection spreading

Recovery

• Hospital stay for several days to weeks, often starting in the ICU for close monitoring.
• Pain management with medications.
• Gradual return to normal activities over several weeks, with specific restrictions on activities such as heavy lifting and intense physical exercise.
• Follow-up appointments for monitoring and imaging studies to ensure complete recovery.

Alternatives

• Antibiotic therapy alone: less invasive but often insufficient for larger or more complex abscesses.
• Image-guided aspiration: minimally invasive but may require multiple procedures and does not remove the abscess entirely.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel any pain.
• Post-procedure, patients may experience headaches, incision site discomfort, and fatigue.
• Pain and discomfort are managed with medications, and supportive care is provided to aid in recovery.