Craniotomy of Tumors Essay Example

Craniotomy of Tumors Essay Example Craniotomy of Tumors Paper Craniotomy of Tumors Paper Surgeries pertaining to the brain for tumor removal are commonly done thru craniotomy. Craniotomy is also performed to examine the brain, remove a blood clot, manage hemorrhage, do biopsy, or to ease pressure inside the skull. The same with other surgeries, the patient will undergo diagnostic procedures prior to craniotomy like: computed tomography scans (CT) or magnetic resonance imaging (MRI) scans. This is done to determine the underlying problem that required the craniotomy as well as to get a better view at the brain’s structure. Angiography of the cerebrum may also be utilized to study the blood supply to the tumor, aneurysm, or other brain lesion. In the case of a tumor in the occipital lobe, the skull will be opened by making a curving incision at the nape of the neck around the occipital lobe. This paper discusses the procedure for a 40-year old, quadriplegic and HIV positive patient. Preparation of the Patient The patient is usually given drugs to ease anxiety. Other medications to reduce the risk of swelling, seizures and infection after the operation may be administered as well. Before and during the surgery, fluids will be restricted; a diuretic may be given if the patient is prone to retaining fluids. Intake of food or drink will not be permitted past midnight the night before surgery. The patient is admitted the morning of the procedure. Catheter will be inserted prior to patient going to the operating room. Since the patient is HIV positive, it is best that the patient’s schedule of operation/surgery will be the latest surgery for the day. Double gloving among the operating room staffs and surgeons should be imperative. Extra care in handling blood and body fluids should be maintained. Being quadriplegic, the patient will then be positioned in a modified fowler’s position HOB elevated 15-20? , patient on his lateral side. During the Procedure General anesthesia is given while the patient lies on the operating table. The head is positioned in a 3-pin skull fixation device once the patient is asleep. The device, which is attached to the table, holds the patient’s head in position during the procedure. A lumbar drain is inserted in the patient’s lower back to help remove cerebrospinal fluid (CSF) that allows the brain to relax during surgery. Additional support may be placed due to the patient’s quadriplegic condition. A skin incision behind the hairline is made after the patient’s scalp has been prepped with an antiseptic. The surgeon makes the incision as far as the thin membrane covering the skull. Many small arteries have to be sealed by surgeon since the scalp is well supplied with blood. The skin flap is then folded back to expose the bone. A circle of holes is made in the skull with a hand drill or a craniotome. A fine wire saw is inserted through the holes by the surgeon to cut the outline of a bone flap to expose the brain. The cut bone flap is taken off exposing the brain protective covering called the dura (Mayfield clinic, 2009). The bone flap is saved until it is replaced at the end of the procedure. Surgery of the underlying cause then commences. The surgeon opens the dura using surgical scissors and exposes the brain. Retractors are used to gently expose a passage to the section needing surgery (restoration or removal). Various very small instruments and tools are used by the surgeon due to the difficulty of moving tissues aside to perform the repair or removal procedure. This is due to the compact structure of the brain. Evoked potential monitoring is oftentimes used to preserve the nerve functions and to ensure that it will not be additionally damaged in the surgery. This is accomplished by stimulating specific cranial nerves while monitoring brain responses. The retractors holding the brain are taken off after the surgery for the underlying cause has been completed and the dura is closed with stitches. The bone flap is put back in its original position and secured with titanium plates and screws. The plates and screws will remain permanently to support the area. In some instances, a drain is placed under the skin for a couple of days to take away blood or fluid from the repaired area. Finally, the surgeon stitches back the membrane, muscle and skin of the scalp together. A soft adhesive or turban-like dressing is placed over the incision. Post Surgery The patient is taken to the recovery room after surgery and vital signs are monitored as the patient regains consciousness (from anesthesia). Oxygen supply remains until the patient fully recovers. Since the patient is HIV positive, constant monitoring is required since the patient is immuno-compromised. Painkillers and drugs are given after the operation to manage any swelling and seizures that may arise are after the operation. Codeine may be given to relieve the headache and nausea that may occur as a result of stretching or irritation of the nerves of the scalp that happens during the craniotomy. An anticonvulsant medication to prevent seizure may also be given. Patient hospital discharge varies from only 2 days to 2 weeks depending on the surgery and complications. In this case, a high probability of complication might develop due to the patient being HIV positive. The bandage on the skull is changed regularly. Stitches or staples are removed 7–10 days after surgery in the doctor’s office. The patient should avoid getting the scalp wet until all the sutures have been removed. A clean cap or scarf can be worn until the hair grows back Reference Mayfield clinic. (2009, January). Craniotomy. Retrieved March 6, 2009, from mayfieldclinic. com/PE-Craniotomy. htm The surgeon marks with a felt tip pen a large square flap on the scalp that covers the surgical area. Following this mark, the surgeon makes an incision into the skin as far as the thin membrane covering the skull bone. Because the scalp is well supplied with blood, the surgeon will have to seal many small arteries. The surgeon then folds back a skin flap to expose the bone. Using a high speed hand drill or an automatic craniotome, the surgeon makes a circle of holes in the skull, and pushes a soft metal guide under the bone from one hole to the next. A fine wire saw is then moved along the guide channel under the bone between adjacent holes. The surgeon saws through the bone until the bone flap can be removed to expose the brain. After the surgery for the underlying cause is completed, the piece of skull is replaced and