Name of the Procedure:

Craniectomy for excision of brain tumor, infratentorial or posterior fossa; midline tumor at base of skull

Summary

A Craniectomy is a surgical procedure where part of the skull is removed to access and remove a brain tumor located in the infratentorial or posterior fossa region, particularly those at the base of the skull. This allows the surgeon to access the tumor safely and effectively.

Purpose

This procedure is performed to treat brain tumors located in the infratentorial or posterior fossa region of the skull. The goal is to remove as much of the tumor as possible to alleviate symptoms, prevent further neurological damage, and possibly cure the patient.

Indications

• Persistent headaches
• Balance and coordination problems
• Neurological symptoms such as vision or hearing issues
• Confirmed diagnosis of a brain tumor in the specified location through imaging studies

Preparation

• Patients may need to fast for 8-12 hours before surgery.
• Medication adjustments might be necessary; certain blood thinners may need to be paused.
• Preoperative imaging tests such as MRI or CT scans are required to plan the surgery.
• Blood tests and a comprehensive medical evaluation will be conducted.

Procedure Description

1. Anesthesia: The patient is put under general anesthesia.
2. Positioning: The patient’s head is secured to provide optimal access to the tumor site.
3. Incision: A scalp incision is made to expose the skull.
4. Bone Removal: A section of the skull (bone flap) is removed to create an opening.
5. Tumor Excision: Using microsurgical techniques, the surgeon removes the tumor. Intraoperative monitoring (such as neuronavigation) may be employed to enhance precision.
6. Closure: After the tumor is removed, the bone flap may be replaced or left off temporarily (depending on the case), followed by closing the scalp incision with sutures or staples.

Duration

The procedure typically takes around 4-8 hours, depending on the complexity and size of the tumor.

Setting

The procedure is performed in a hospital operating room equipped for neurosurgery.

Personnel

• Neurosurgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologist
• Neurophysiologist (if intraoperative monitoring is used)

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Swelling of the brain
• Neurological deficits (e.g., speech, movement complications)
• Cerebrospinal fluid leak
• General anesthesia risks

Benefits

• Relief from symptoms caused by the tumor
• Improved quality of life
• Potential complete removal of the tumor, which may result in a cure or extended survival

Recovery

• Observation in the Intensive Care Unit (ICU) immediately after surgery
• Pain management and antibiotics to prevent infection
• Gradual increase in activity as tolerated
• Follow-up appointments for monitoring recovery and to assess any need for adjunct therapies (e.g., radiation, chemotherapy)
• Recovery time varies but usually ranges from several weeks to a few months

Alternatives

• Stereotactic radiosurgery (e.g., Gamma Knife)
• Chemotherapy and radiation therapy
• Watchful waiting in cases of slow-growing, asymptomatic tumors
• Pros and cons of alternatives depend on the size, location, and type of tumor, and patient health status

Patient Experience

• The patient will be under anesthesia during the procedure and will not feel anything.
• Post-surgery, the patient may experience headache and discomfort, which are managed with pain medication.
• Hospital stay ranges from a few days to a week, depending on recovery speed.
• There may be activity restrictions and the need for physical therapy to aid in full recovery.