Learning objectives
- Describe the principle, indications and contraindications of craniotomy
- Manage patients undergoing craniotomy
Definition
- Craniotomy is a surgical procedure in which a part of the skull is temporarily removed to expose the brain and perform an intracranial procedure
Indications
- Brain aneurysm
- Vascular malformations (arterio-venous malformation, cavernous angioma, arterio-venous fistula)
- Brain tumors (meningioma, high-grade and low-grade glioma, epidermoid, ependymoma, oligodendroglioma, metastases)
- Orbital tumors
- Pituitary adenomas
- Cerebellopontine angle tumors
- Pain treatment (microvascular decompression)
- Brain abscess
- Subdural empyema
- Hematomas (intracerebral, epidural, subdural)
- Decompressive craniectomy
- Lobectomy
- Epilepsy surgery
- Craniosynostosis
- Depressed skull fractures
- Intracranial foreign bodies
- Cerebrospinal fluid leak repair
Contraindications
- Advanced age
- Poor functional status
- Severe cardiopulmonary disease
- Severe systemic collapse (sepsis, multiorgan failure)
- Pathologies that can be addressed by a single burr hole
- Altered preoperative coagulation parameters
- Bleeding disorders
Management
![craniotomy, electrocardiogram, blood count, electrolyte, ICP, intracranial pressure, CPP, cerebral perfusion pressure, sedatives, airway, sympathetic, propofol, remifentanil, sevoflurane, paralysis, laryngoscopy, arterial line, urinary catheter, ECG neurophysiological monitoring, SSEP, MEP, EMG, EEG, hemorrhage, venous air embolism, seizure, hemodynamic instability, emergence, analgesia, NSAID, antiemesis, dexamethasone, ondansetron](https://www.nysora.com/wp-content/uploads/2023/01/Craniotomy-management-2.jpg)
SSEP, somatosensory evoked potential; MEP, motor evoked potential; EMG, electromyography; EEG, electroencephalography
Suggested reading
- Fernández-de Thomas RJ, De Jesus O. Craniotomy. [Updated 2022 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560922/
- Keown, T., Bhangu, S. and Solanki3, S. (2022) Anaesthesia for craniotomy and brain tumour resection, WFSA. Available at: https://resources.wfsahq.org/atotw/anaesthesia-for-craniotomy-and-brain-tumour-resection/ (Accessed: January 18, 2023).
- Dinsmore J. Anaesthesia for elective neurosurgery. BJA: British Journal of Anaesthesia. 2007;99(1):68-74.
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