Name of the Procedure:

Craniectomy for Excision of Brain Tumor, Infratentorial or Posterior Fossa; Cerebellopontine Angle Tumor

Summary

A craniectomy for the excision of a brain tumor located in the infratentorial or posterior fossa region, specifically at the cerebellopontine angle, is a surgical procedure where part of the skull is removed to access and remove a tumor located at the junction of the cerebellum and pons.

Purpose

The procedure addresses brain tumors in the cerebellopontine angle, which can affect balance, coordination, and cranial nerve function. The goals are to remove the tumor to alleviate symptoms, prevent further neurological deterioration, and improve the patient's quality of life.

Indications

• Symptoms such as dizziness, hearing loss, facial numbness or weakness, and problems with balance
• Diagnosis of cerebellopontine angle tumors like acoustic neuromas or meningiomas
• Tumor growth that poses a risk of severe neurological complications

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Medication adjustments may be necessary, especially if blood thinners are involved.
• Preoperative imaging tests like MRI or CT scans to map the tumor's location.
• Preoperative blood tests and assessments to ensure the patient is fit for surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision in the scalp and temporarily removes a portion of the skull (craniectomy) to access the brain.
3. The dura mater is opened to expose the tumor.
4. Microsurgical instruments and techniques are used to carefully excise the tumor while preserving surrounding brain tissue and nerves.
5. Hemostasis is achieved to control bleeding.
6. The dura mater is closed, and the removed bone segment may be replaced or left out to accommodate swelling, and the scalp is sutured back.

Duration

The procedure typically takes between 4 to 8 hours, depending on the tumor's size and complexity.

Setting

The procedure is performed in a hospital's neurosurgery operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding and blood clots
• Neurological deficits such as weakness, numbness, or cranial nerve damage
• Cerebrospinal fluid leaks
• Swelling or edema in the brain
• Seizures

Benefits

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

Recovery

• Post-procedure care in the Intensive Care Unit (ICU) for close monitoring
• Gradual return to normal activity with physical therapy if necessary
• Pain management with prescribed medications
• Follow-up appointments for monitoring recovery and any additional treatment if needed
• Recovery can take several weeks to months, depending on individual patient factors.

Alternatives

• Stereotactic radiosurgery (e.g., Gamma Knife)
• Conventional radiation therapy
• Watchful waiting in asymptomatic or slow-growing tumors

Pros and Cons of Alternatives:

• Radiosurgery and radiation therapy may be less invasive but may not completely remove the tumor.
• Watchful waiting avoids immediate surgery risks but carries the risk of the tumor growing and causing symptoms later on.

Patient Experience

Patients may feel groggy and sore immediately after the procedure. Some may experience headaches, nausea, and fatigue during recovery. Pain is managed with medications, and comfort measures include bed rest and gradual physical activity. Post-operative support includes physical and occupational therapy tailored to help regain strength and coordination.