Like any other part of the body, the brain is exposed to problems such as bleeding, infection, trauma and other injuries. There is a need for surgical intervention in order to diagnose or treat problems. Craniotomy (craniotomy) - type of brain surgery. There are several types of surgical procedures on the brain, but the recovery after trepanation is the same as in the majority of cases. It is performed more often.
Craniotomy clinic Assuta opens unlimited possibilities in the correction of complex diseases and brain injuries. Benefits of treatment in private medical hospital are undeniable:
- Treatment are the best neurosurgeons of the country, heads of specialized branch of the Israeli hospitals, trained in leading Western clinics.
- Revolutionary technical equipment of operating rooms, the availability of robotic systems, navigation systems.
- Fast terms of the organization of treatment - diagnosis and preparation of therapeutic protocol takes only 3-4 days.
We are waiting for you to be treated in specialized departments Assuta network. Reasonable prices, a professional approach, individual treatment regimen.
There are a number of lesions and abnormalities that affect the skull and its contents, and requires a craniotomy:
- Skull. The most common problem - a benign tumor.
- Brain. The most common cause is the treatment - glioma, brain metastases from other organs, an abscess (a localized infection).
- Shell. These fabrics are mostly hit benign tumors - meningioma, which increase in size and put pressure on the brain, causing damage to it.
- Blood vessel. Vessels in the brain can affect base aneurysm, which can result in rupture and hemorrhage around the brain (subarachnoid haemorrhage).
- Cerebrospinal fluid. The emergence of obstacles likvorobraschenii leads to hydrocephalus (swelling of the brain), which in some cases requires a craniotomy.
In what cases do craniotomy - general indications:
- Inspection of visible brain problems.
- Severe traumatic brain injury or head trauma.
- Removal of a blood clot or hematoma.
- Biopsy - taking a sample of tissue to check for cancer cells.
- Drainage hearth brain abscess.
- Reducing the pressure in the skull due to a tumor.
- For the control of bleeding caused by an aneurysm.
- Restoration of blood vessels.
- Benign and malignant tumors of the brain.
- Nervous disorders.
- brain infection.
If left untreated, any condition requiring surgery, will cause further damage.
There are several methods craniotomy, a choice influenced by the type of operation, which is followed by:
- Traditional trepanation - bone flap and the skull was removed at the beginning of the operation and return to the place in the completion.
- Endoscopic craniotomy is performed through a small hole in the skull through the endoscope.
- Stereotactic craniotomy - a standard method of research is complemented by MRI and CT. As a result, the surgeon receives a three-dimensional image with a precise localization of the fire. The advantage of a technique - it clearly separates the healthy from the pathological tissue.
Diagnostics in the clinic Assuta may include physical examination, blood tests, ECG, chest X-ray. Neuroimaging performed by CT or MRI, arteriogram.
Before the surgery the patient may prescribe medication to relieve anxiety, reduce risk of seizures, infection and edema after surgery. Correlated reception means, blood thinners (heparin, aspirin) and steroidal anti-inflammatory drugs (ibuprofen, Motrin, advila) due to the increased likelihood of thrombus formation after craniotomy. Their reception was stopped for 7 days minimum.
When the diagnosis of brain tumor prescribe steroids. They eliminate edema caused neoplasm. Treatment continues after craniotomy of the exact medical prescription. It is important to strictly follow the instructions. The consequence of taking steroids is stomach irritation. To reduce it, you need to take the tablets with food or a glass of milk. Sometimes prescribe drugs to prevent irritation.
1-2 weeks prior to surgery the patient stops smoking, chewing tobacco and drinking alcohol. These actions cause complications during and after surgery, slow healing of the operated area.
The nurse will instruct when to stop eating and drinking before craniotomy, usually for 8-12 hours before the procedure.
Assuta Hospital patient in a hospital gown, and provide special stockings that help prevent deep vein thrombosis. After surgery, there is a risk of unwanted effects due to the prolonged absence of movement.
Surgeon talking with the patient about the surgery, side effects and complications. The patient signs a consent form. the patient also meets with the anesthesiologist.
How do craniotomy?
Traditional craniotomy involves the following steps:
- On the treated area shaved hair.
- The patient is given general anesthesia. A local anesthetic is injected into the skin of the head, in order to reduce post-operative pain.
- Head is fixed on a special headrest to the treated area was available. Movement minimized by holding the head by a special device with three bolts placed on the outer surface of the skull.
- Using the pre-scan and application neurosurgeon neuronavigation system determines the most suitable place for craniotomy. The procedure starts with the scalp incision.
- high power drill is drilled in the skull through the small holes.
- Craniotome (surgical instrument for cranial perforation) is used to create a removable bone flap (it is formed between the holes). This allows access to the brain.
- Further, depending on the diagnosis - recovering blood vessels, removes the thrombus or tumor.
- At the end of the operation the bone flap is put in place, fixed with special clamps, the muscles and the skin is sutured. Placed inside the brain drain to remove excess blood, fix it one seam. Because the wound heals faster.
The duration of surgery of about 2.5 hours.
Recovery from craniotomy
The patient regains consciousness in the intensive care unit Assuta Hospital. Nurses provide specialized care. As long as the patient does not recover from anesthesia for several hours using an oxygen mask.
Immediately after craniotomy tested the reaction of the pupil, after anesthesia is assessed mental state, the movement of the extremities (arms and legs).
Blood pressure is carefully controlled with the pulse. The catheter is inserted into the artery can be used for continuous pressure monitoring. Intracranial pressure is controlled via a small catheter placed inside the head and connected to a manometer.
Nurses taking blood samples to determine the level of red blood cells and the amount of sodium and potassium.
Provided intravenous injection - the body of the patient enters saline. When the patient will be able to make their own food and fluid infusion clean.
Shortly after the operation, the patient starts breathing exercises to cleanse the lungs. He will be able to get up about a day after trepanation.
To control pain, swelling and cramps prescribe medication. Prescribe antibiotics to prevent infections.
Drainage is removed the next day. Swelling and bruising will be present the first time on the face.
Surgical staples are removed 5-7 days after craniotomy. The head can not be wetted to remove staples.
In the clinic, the patient usually stays for five days, in some cases - for longer. Prescribe medication that will be needed after surgery.
Long-term observation is required if it is an infection or tumor.
Infection requires such a state as brain abscess. Doctor prescribes specific antibiotics for infectious agent causing abscess. In some cases, the reception last several months.
Follow-up care at a tumor depends on its nature - benign or malignant.
Patients with benign tumors occur in doctors several years to ensure no recurrence. If the illness returns, the operation is repeated, or radiation therapy.
Malignant tumors have a different perspective. Apply additional treatments:
- Irradiation is carried out after removal of metastatic foci and the tumors which arose directly into the brain, for example, glioblastomas. The survival rate is doubled after surgery followed by radiotherapy.
- Chemotherapy is used for glioblastoma, but often helps slightly, also causes unwanted side effects.
- Immunotherapy boosts the immune system. When glioblastoma tumor often taken during an operation for making a vaccine. The introduced the vaccine stimulates the blood cells to create cells that will find and attack the pathological focus. Early studies showed that immunotherapy to improve survival in some patients, causing minimal side effects.
Rehabilitation after craniotomy
Full recovery can take up to two months, but most patients return to normal life in less time.
Of recovery depends on the following factors:
- Kind of a traumatic brain injury.
- The severity of the injury.
- The presence or absence of neurological problems.
- Type of transaction.
- Side effects or complications post-operative treatment.
- The age and general health, including the presence of other diseases.
There may be feelings of fatigue and anxiety to eight weeks after craniotomy. This is normal, need to nap in the afternoon. The question of the return to work will be discussed with the doctor. If the activity does not involve working load, approximately 6 weeks to start it.
Some patients require physiotherapy or occupational therapy. Sometimes you need a speech therapist help with speech difficulties. These methods help to cope with any neurological problems.
The following activities during the recovery should be avoided:
- Driving. The car will be driving after 3 months.
- Contact sports - at least a year.
- Stay in a sitting position for a long time.
- Lifting heavy objects - no more than 2.25 kg.
- Engaged in housekeeping (loading / unloading the washing machine or dishwasher, vacuuming, ironing, mowing the lawn or gardening).
After discharge, the necessary drugs, painkillers are appointed. About two weeks may experience headaches. Some analgesics cause constipation. It is recommended to eat more fruits, vegetables and fiber, drink plenty of fluids. Alcohol interacts with some medications, so it is important to consult a doctor beforehand.
The wound may hurt a few days after the craniotomy. As healing occurs itching. Possible swelling in the area. A few months numbness on one side of the wound can be observed.
Some patients experience attacks before or after craniotomy. In this case, prescribed anticonvulsants. If you experience side effects, it is important to consult a doctor.
It requires specialist help if you encounter any signs of wound infection or any other unusual symptoms - severe headache, convulsions, vomiting, confusion, or chest pain.
Craniotomy - effects after surgery
Every surgery carries a risk. Complications after craniotomy - infrequent. On the likelihood of side effects is influenced by such factors as the type of brain damage, general health and age.
The surgeon will explain the potential complications of the patient and will give an idea of the risk of their occurrence:
- Leakage of cerebrospinal fluid (the fluid surrounding the brain).
- Deep vein thrombosis.
- Pulmonary embolism.
- Heart attack.
- Damage to the scalp because of the locking device.
- Injuries of the facial muscles.
- Damage to the sinuses.
- Damage to the brain, which can cause impairment or loss of function - deafness, diplopia, numbness, paralysis, blindness, loss of smell, loss of memory.
- swelling of the brain.
- Allergic reactions to the anesthetic.
- Urinary tract infections.
- Infection of the bone flap.
Some of these effects craniotomy rather serious and life-threatening. The frequency of occurrence was 5%.
Questions that you can ask your doctor to Assuta:
- As the operation is performed?
- What kinds of tests and training are required before surgery?
- What are the risks associated with craniotomy?
- How often observed damage to healthy brain tissue during such an operation?
- What is the expected outcome of the craniotomy?
- What complications can occur?
- How much time is required for recovery?
- How many of these operations were carried out last year in the clinic?