Name of the Procedure:

Craniectomy for excision of brain tumor, infratentorial or posterior fossa. (Excludes meningioma, cerebellopontine angle tumor, or midline tumor at the base of the skull.)

Summary

A craniectomy is a surgical procedure where part of the skull is removed to access the brain. This specific type targets tumors located in the infratentorial or posterior fossa regions.

Purpose

This procedure aims to remove brain tumors in the infratentorial or posterior fossa areas to alleviate symptoms, prevent further neurological damage, and potentially eliminate the tumor.

Indications

• Persistent headaches
• Balance and coordination problems
• Hearing loss or ringing in the ears
• Difficulty with facial movements or expressions
• Known diagnosis of a brain tumor in the specified regions

Preparation

• Patients will need to fast for 8 hours before surgery.
• Pre-procedural imaging (MRI or CT scans) will be done.
• Adjustments in medications, particularly blood thinners, may be required.
• Routine blood tests and possibly a pre-operative physical examination.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision in the scalp over the tumor location.
3. A portion of the skull is removed to expose the brain.
4. The tumor is carefully excised using specialized surgical tools and microscopes.
5. Hemostasis is achieved to manage bleeding.
6. The skull piece may be replaced, or the area may be left open (depending on the case).
7. The scalp is sutured back into place.

Duration

Typically, the procedure lasts between 4 to 6 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Swelling of the brain
• Neurological deficits such as speech, movement, or balance issues
• Seizures
• Complications related to general anesthesia

Benefits

• Potential complete removal of the tumor
• Relief from symptoms caused by the tumor
• Prevention of further neurological damage

Recovery

• Hospital stay of 5-7 days, with initial ICU monitoring.
• Pain management will be necessary.
• Gradual return to normal activities over several weeks to months.
• Follow-up appointments for monitoring recovery and removal stitches/clips.

Alternatives

• Stereotactic radiosurgery
• Chemotherapy or radiation therapy
• Observation (if the tumor is slow-growing or asymptomatic)
• Pros: Less invasive alternatives may be appropriate for smaller or less aggressive tumors.
• Cons: Surgery is often required for complete removal and symptom relief of larger or more aggressive tumors.

Patient Experience

• Patients typically experience some post-operative pain, managed with medication.
• Possible initial neurological deficits which may improve over time.
• Some discomfort from scalp incisions; a temporary feeling of fatigue.
• Support for functional recovery, often through physical or occupational therapy.