Name of the Procedure:

Craniectomy, Trephination, Bone Flap Craniotomy for Excision or Fenestration of Cyst, Supratentorial

Summary

A craniectomy, trephination, or bone flap craniotomy is a surgical procedure that involves removing part of the skull to access and remove or fenestrate (create an opening in) a cyst located above the tentorium in the brain.

Purpose

This procedure is performed to treat supratentorial cysts, which can cause symptoms such as headaches, seizures, or neurological deficits. The goal is to alleviate pressure on the brain, relieve symptoms, and prevent further complications.

Indications

• Persistent headaches
• Seizures
• Neurological deficits (e.g., weakness, vision problems)
• Increased intracranial pressure
• Confirmed diagnosis of a cyst via imaging (e.g., MRI, CT scan)

Preparation

• Fasting for at least 8 hours before the procedure
• Medication assessment and adjustments (e.g., stopping blood thinners)
• Pre-operative imaging studies (MRI, CT scan)
• Blood tests and other routine pre-surgical assessments

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A scalp incision is made over the area of the cyst.
3. Bone Removal: A portion of the skull (craniectomy or bone flap craniotomy) is removed to access the brain.
4. Access Cyst: The dura mater (outer membrane of the brain) is opened to reach the cyst.
5. Excision/Fenestration: The cyst is either removed or fenestrated to allow fluid to drain.
6. Closure: The dura mater is closed, the bone flap is replaced (if applicable), and the scalp is sutured.

Duration

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

Setting

The procedure is performed in a hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Brain swelling
• Seizures
• Neurological deficits
• CSF leakage
• Reaction to anesthesia

Benefits

• Relief from headaches and seizures
• Improvement or resolution of neurological symptoms
• Decreased risk of cyst-related complications

Recovery

• Initial recovery in the Intensive Care Unit (ICU) for close monitoring
• Hospital stay of 5-7 days
• Gradual return to normal activities over several weeks to months
• Follow-up appointments for monitoring recovery and further imaging

Alternatives

• Observation and regular monitoring if the cyst is asymptomatic
• Stereotactic aspiration (less invasive)
• Endoscopic cyst fenestration (minimally invasive)
• Each alternative varies in invasiveness and effectiveness; discuss with the healthcare provider for the best option.

Patient Experience

• General anesthesia ensures no pain during the procedure.
• Post-operative pain and discomfort are managed with pain relief medications.
• Some patients may experience fatigue, headaches, or mild confusion during recovery.
• Gradual improvement in symptoms as healing progresses. Regular follow-up is critical for optimal outcomes.