Name of the Procedure:

Craniotomy with elevation of bone flap; for excision of craniopharyngioma
Common name(s): Craniotomy for tumor removal, Excision of craniopharyngioma

Summary

A craniotomy with the elevation of a bone flap for the excision of a craniopharyngioma is a surgical procedure where a portion of the skull is temporarily removed to access the brain and remove a tumor called a craniopharyngioma. This tumor is typically located near the pituitary gland and can affect hormonal balance and vision.

Purpose

This procedure addresses the presence of a craniopharyngioma, a benign tumor that can cause significant symptoms and complications due to its proximity to critical brain structures. The goals are to remove the tumor, alleviate symptoms such as headaches and vision problems, and restore normal function as much as possible.

Indications

• Persistent headaches
• Visual disturbances or loss of vision
• Hormonal imbalances affecting growth, metabolism, and other bodily functions
• Evidence of tumor growth on imaging studies (e.g., MRI or CT)
• Hydrocephalus (fluid buildup in the brain) requiring intervention

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments to regular medications as advised by the healthcare provider
• Pre-operative imaging studies like MRI or CT scans
• Blood tests and medical evaluations to ensure patient readiness for surgery

Procedure Description

1. The patient is placed under general anesthesia to ensure they are unconscious and pain-free during the surgery.
2. The surgeon makes an incision in the scalp and temporarily removes a section of the skull bone (bone flap) to access the brain.
3. Using specialized surgical tools and microscopes, the surgeon carefully locates and removes the craniopharyngioma.
4. The bone flap is then repositioned and secured, and the scalp incision is closed with sutures or staples.
5. The patient is monitored in the recovery area before being moved to a hospital room for further observation.

Duration

The procedure typically takes 4 to 6 hours, depending on the complexity and size of the tumor.

Setting

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

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians
• Neuro-monitoring specialists (if needed for brain function monitoring)

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Swelling in the brain
• Seizures
• Neurological deficits (e.g., weakness, speech difficulties)
• Hormonal imbalances requiring lifelong hormone replacement therapy

Benefits

• Removal of the tumor can alleviate symptoms like headaches and visual disturbances.
• Improved hormonal function and overall quality of life.
• Prevention of further complications related to tumor growth.

Recovery

• Hospital stay of several days to weeks, depending on individual recovery
• Post-operative care includes pain management, monitoring for neurological changes, and gradual resumption of activities.
• Follow-up appointments for imaging studies and hormone evaluations.
• Potential for physical therapy and rehabilitation if neurological impairments occur.

Alternatives

• Medication management for hormone-related symptoms
• Radiation therapy (though generally used when surgery is not an option or cannot fully remove the tumor)
• Watchful waiting with regular monitoring if the tumor is small and asymptomatic

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, they may experience headaches, nausea, and discomfort at the surgical site. Pain management will be provided, and gradual improvement is expected over weeks to months. Close communication with the healthcare team is essential for optimal recovery and managing any complications.

This markdown description provides a comprehensive overview of the procedure in a structured format, making it easy to understand for both patients and healthcare providers.