Craniotomy is an operation technique. Bilateral osteoplastic trepanation in the frontal region

The type of operation directly depends on the pathology that led to it. Therefore, the opening of the skull can be carried out on one or both sides. Operations are:

temporal - in the temple area;
frontal and bifrontal - in the frontal part;
suboccipital - in the back of the skull.

Osteoplastic

Most often, osteoplastic surgery is performed, which can rightly be called traditional. The algorithm for its implementation looks quite simple: a horseshoe-shaped or oval incision is made at the base of the skull, the bone is temporarily removed, manipulations are performed on the brain, and then the bone is returned to its place, the skin is sutured.

The bone is usually cut out with a wire saw or a special tool called a pneumoturbotrepan at an angle of 45 degrees to prevent the bone flap from falling into the body of the brain and is fixed with a suture to the periosteum. Indications for surgical intervention are:

Carrying out the skull opening procedure becomes relevant for inoperable brain tumors, and its sole purpose is to reduce intracranial pressure. With a known position of the tumor, an incision is made above it, with an unknown one, they start from the temple on the side of the working hand (right for a right-hander, left for a left-hander), so that speech impairment does not become a complication.

The bone flap is not returned after the operation to prevent pressure buildup, and the hole in the skull is closed with synthetic materials.

Craniotomy (craniotomy) differs from other open-brain manipulations in that the patient is conscious, that is, local, rather than general, anesthesia is in effect. He is given sedatives, and if necessary, general anesthesia is administered.

Cranioplasty is the procedure of replacing a bone flap with artificial tissue.

In modern medicine, trepanation of the skull is also called craniotomy (but not trepanation of the brain). Another name does not change the fact that this is a very complex surgical procedure. The emergence of new methods of dealing with many diseases of the brain allows you to resort to it less often than before.

Features of osteoplastic craniotomy

Trepanation is done when you need to access directly the contents of the skull for surgical treatment:

The operation begins with choosing a location for the burr hole: it should be as close as possible to the affected area. First of all, the surgeon cuts soft tissues in the form of a horseshoe in such a way that the base of the flap is located in the lower part, since the blood vessels pass from the bottom up, and it is very important not to violate their integrity.

Further, with the help of special instruments, the periosteum and bone are dissected at an angle of 45 °. Such a cutting angle is needed so that the outer surface of the bone flap exceeds the inner one, and when the integrity of the skull is restored, the removed fragment does not fall inward.

The craniotomy ends with suturing:

the hard shell of the brain is sutured with absorbable threads;
the flap is fixed with special threads or wire;
skin and muscles are sutured with catgut.

Resection trepanation

The pretexts for resection craniotomy are pathologies that provoke a rapid increase in intracranial pressure, life-threatening, or contribute to the displacement of brain structures, which is fraught with their infringement and death. These states include:

hemorrhage in the brain;
swelling of the brain;
injuries (bruises, hematomas, crushing of tissues as a result of impact);
large inoperable tumors.

Trepanation in such cases is a palliative procedure, that is, it does not eliminate the disease, but only eliminates a dangerous complication.

The best place for the operation is the temporal zone. Here, the shell of the brain after the removal of the bone flap will be protected by a powerful temporal muscle.

How is resection trepanation of the skull done? As with osteoplastic craniotomy, soft tissues and bone are cut. The bone fragment is removed so that the diameter of the hole is 5 - 10 cm. Having found the swelling of the brain membrane, the surgeon is in no hurry to dissect it so that there is no displacement of the brain structures.

To eliminate intracranial hypertension, you first need to make several punctures of the cerebrospinal fluid, and then cut the meninges. When this manipulation is done, the tissues (with the exception of the dura mater) are sutured.

Craniotomy of any kind can last several hours, and it is used only for serious indications that threaten the patient's life. No one will perform such an operation, for example, with a microstroke - there are more gentle methods of therapy to eliminate its consequences.

To eliminate many pathologies, trepanation is used, the types of which are named based on the localization of access to the brain and the method of performing the operation. The bones of the skull (on the vault) are represented by several plastics covered with periosteum from above and adjacent to the meninges from below.

classical osteoplastic;
resection;
for the purpose of decompression;
operation in consciousness;
stereotaxia is the study of the brain using a computer.

Osteoplastic craniotomy

The most famous type of craniotomy, the classic method of opening the skull, during which a small section of the parietal bone is cut out without damaging the periosteum. The sawn piece is connected with the help of the periosteum with the cranial vault.

The skin flap on the leg is folded back and after the operation is put in place or removed. The periosteum is stitched. After surgery, no bone defect is observed. Trepanation (osteoplastic) of the skull is divided into two types:

With cutting out the skin-periosteal-bone flap at the same time (according to Wagner-Wolf).
With cutting out a skin-aponeurotic flap with a wide base, and then a bone-periosteal flap on a narrow stalk (Olivekron trepanation).

Decompressive trepanation

One of the methods designed to reduce intracranial pressure and improve the condition (and functioning) of the brain is decompressive cranial trepanation (DCT) or Cushing trepanation, named after a famous neurosurgeon. With it, a hole is created in the bones of the skull through which the harmful element that caused the resulting hypertension is eliminated.

Resection trepanation

A resection operation has a less favorable prognosis for rehabilitation, craniotomy with it takes place by applying a burr hole and then expanding it to the required size (nippers are used for this).

The sawn area is removed along with the periosteum without possible recovery. The bone defect is covered with soft tissues. As a rule, this technique is used when trepanation of the posterior cranial fossa is necessary, as well as the treatment of craniocerebral wounds.

Awake craniotomy

One of the modern methods of surgery is trepanation without anesthesia. The patient is conscious, his brain is not turned off. He is injected with drugs to relax and inject local anesthesia. Such an intervention is required when the area with pathology is located too close to the reflexogenic zones (and there is a danger of damaging it).

The traditional type of surgery to remove the tumor is craniotomy. It is performed under general anesthesia and consists in removing the neoplasm through an artificial opening in the skull.

After removal of the tumor, the patient is taken out of anesthesia for a very short time. This is necessary to determine the possible dysfunction of the disturbed part of the brain.

As soon as all the necessary manipulations are carried out, the bone is returned to its original position and fixed with screws. To prevent the spread of cancer cells to healthy tissues, radiation therapy is performed after removal of the brain tumor. This helps to destroy the malignant cells that did not fall under the removal.

Despite the fact that trepanation is considered the classic way to perform such an operation, today there are quite a few more gentle methods of surgical removal of the tumor.

laser surgery. During its implementation, a laser beam is used. The main advantages of this type of surgical intervention include the complete absence of capillary bleeding and the natural sterility of the laser. This factor prevents the possibility of tissue infection. In addition, during the operation performed with the help of a laser, the transition of cancer cells to healthy ones is completely excluded, which cannot be said about the traditional operation.

The principle of operation of the gamma knife

Which method of surgical intervention to use when removing the tumor is decided by the specialist, after examination and a complete examination of the patient. If possible, the patient may be offered several types of surgery to choose from, after which a joint decision is made to use the method of treatment that is optimal in a particular situation.

What are the consequences for children and adults

Asthenia - a constant feeling of fatigue, depression, sensitivity to atmospheric phenomena, insomnia, tearfulness;
Speech disorders– often occurs in both children and adults. It is difficult to immediately determine whether this phenomenon is temporary. So you just have to wait and watch;
Psychosis;
forgetfulness;
paralysis;
Seizures (more common in children);
loss of coordination(more pronounced in children);
Hydrocephalus (in children, less often in adults);
ZPR (in children).

Infectious complication

As after any surgical intervention, trepanation negatively affects the protective functions of the body, which increases the risk of infection.

Brain infections are extremely rare, but the wound itself is easy to infect by poorly treating the instruments.

for surgery or materials for dressings.

OPERATING ROOM EQUIPMENT AND SURGICAL INSTRUMENTS.

All neurosurgical operations require special equipment and instruments in the operating room, although in certain cases they can be performed in general operating rooms with a small number of special instruments. A modern neurosurgical operating room should be equipped with a special operating table with headrests, a shadowless lamp, an electrocoagulation apparatus and an aspirator for sucking blood from a wound, a forehead reflector, lighting lamps for manipulations in the deep parts of the brain, devices for recording blood pressure, pulse, respiration, as well as brain biocurrents.

From the instrumentation follows, in addition to the general surgical

tools should have a manual trephine with a set of cutters of various shapes and diameters; wire saws of Gigli or Olivekron with conductors for them, resection forceps of Egorov, Dahlgren, forceps of Luer; spoons, fenestrated tweezers to remove the tumor; neurosurgical scissors for dissection of the meninges, retractors, hemostatic clamps - straight or curved, clips, a set of brain spatulas made of bendable metal, cannulas for puncturing the brain and its ventricles.

PRINCIPLES OF CRANIAL CRANEPANIA.

Trepanation is an operative access that allows performing surgical intervention on the brain and its membranes. It is usually accepted to separate in the description the trepanation of the supratentorial parts of the cranial vault with the trepanation of the posterior cranial fossa, which is associated with the peculiarities of the anatomical structure of the organs of the posterior cranial fossa, in particular, the proximity of the medulla oblongata and the spine.

Indications: to gain access to various intracranial formations for the purpose of their surgical treatment (removal of volumetric processes, clipping of aneurysms, etc.). With modern diagnostic capabilities, trepanation as a method of final diagnosis of the disease is rarely used.

Contraindications can be absolute and relative. Absolute contraindications are a violation of the blood coagulation system, respiratory and cardiac activity, acute septic conditions and severe damage to internal organs. The poor condition of the patient is not always a contraindication, since sometimes only surgical intervention on the intracranial volumetric process can improve it.

The operation is performed under anesthesia or, less commonly, under local anesthesia.

In order to reduce cerebral edema, dehydrating agents are often used before surgery. The introduction of mannitol, urea, lasex, or others immediately before the operation has become widespread, since they have a pronounced dehydrating effect, due to which the volume of the brain decreases and it becomes possible to more easily push the brain tissue to access more deeply located areas of the base of the skull and brain. But it should be noted that mannitol and urea can still increase blood volume and bleeding during surgery.

Any surgical intervention in the cranial cavity should be performed with minimal trauma to the brain tissue and careful hemostasis, and involuntary damage to the brain tissue is allowed only in functionally insignificant areas. All exposed areas of the brain should be covered with thin strips of damp cotton. The retraction of the lobes of the brain should be done slowly, gradually, without excessive trauma, using metal easily bending spatulas of various sizes.

Hemostasis is carried out with the help of coagulation of vessels, their compression with thin metal brackets (clips), temporary tamponade with gauze turundas, pieces of a fibrin sponge that easily swells in liquid. The operating field should be clearly visible and free from blood. Electric aspirators are used to remove blood and cerebrospinal fluid.

At the end of the main stages of surgical intervention in the cranial cavity, complete sealing of the subarachnoid space should be ensured by carefully suturing the incision of the dura mater or closing the defects of this membrane in a plastic way and layer-by-layer suturing of the wound. In the postoperative period, as a rule, there is hypersecretion of CSF as a reaction to surgery.

In the absence of a thorough isolation of the subarachnoid space from the external environment, the liquor begins to flow into the bandage, a prolonged liquorrhea sets in, and there is a danger of a secondary infection penetrating the liquor pathways and developing purulent meningitis.

TREPANATION METHODS.

Opening the cranial cavity and exposing various parts of the cerebral hemispheres is carried out by two methods:

a) trepanation of the bone by applying a burr hole and expanding it with the help of nippers to the required size (resection trepanation). In this case, the incision of the soft tissues of the skull can be either linear or horseshoe-shaped. The main disadvantage of this method is that it leaves a permanent bone defect;

b) osteoplastic trepanation with folding the skin flap on the leg, which by the end of the operation is either removed or put in place. In all possible cases, preference is given to osteoplastic trepanation.

In the second half of the last century and in the first decades of the 20th century, osteoplastic trepanation was usually performed according to the method of Wagner and Wolf. At the same time, a horseshoe-shaped skin-periosteal-bone flap is cut out on a relatively narrow common skin-muscular-periosteal pedicle. After skeletonization of the bone in a narrow groove along the incision of the soft tissues, 4-5 burr holes are placed, between which the bone is cut with a wire saw.

Over the past decades, the technique of osteoplastic trepanation proposed by Zutter and developed by Olivekron has become widespread. First, a large skin-aponeurotic flap is cut out and folded aside on a wide base, and then a separate bone-periosteal (or osteo-muscular-periosteal) flap is cut out on an independent leg from soft tissues formed from subaponeurotic loose fiber and periosteum, and often the temporal muscle .

A horseshoe-shaped incision according to Wagner-Wolf is less beneficial in terms of maintaining good blood circulation of the skin-subcutaneous flap than the formation of a curved incision with the preservation of a wide pedicle in the anterior and lower sections. The advantage of the latter method is that the separate formation of skin and skin-periosteal flaps allows to vary the location and expansion of the bone-periosteal flap to a large extent, regardless of the size and location of the skin-aponeurotic flap.

But recently, horseshoe-shaped incisions of the scalp have been abandoned and only linear ones are used. Their advantages are that they are much shorter than horseshoe-shaped ones, the projection of the skin incision does not coincide with the projection of the incision of the dura mater of the brain, which is very important when decompression is left, nerves with vessels are better preserved, since the incision usually runs parallel to them, and, in the end after all, they never reach the frontal region of the face, that is, they are very cosmetic.

TECHNIQUE OF THE OPERATION.

The position of the patient and his head on the operating table.

When choosing the position of the patient and his head during the operation, local, general and anesthetic requirements are taken into account.

Local requirements are the optimal exposure of the brain and approach to the area of operation, a comfortable position for the surgeon.

General - the position of the patient and his head should not worsen his condition and should not cause complications (hemodynamic - venous congestion, nerve compression, air embolism).

Anesthesiological requirements - not to impede the excursion of the chest and breathing, to create access for the possible implementation of resuscitation during the operation.

The position of the patient on the operating table may be different and depends on the localization of the process. In diseases of the brain, the patient and his head are placed in the position:

on the back of the head - to expose the frontal lobes, the base of the anterior cranial fossa, the chiasm region;

on the back of the head with a head turn of 15-30 in the direction opposite to the focus of the operation - for surgical access to the temporal and parietal areas. The body is also simultaneously rotated by 15-30 with the help of a table or lining;

on the side to access the temporal, parietal, occipital regions;

sitting - for surgical access to the formations of the posterior cranial fossa, upper cervical spine;

sitting, turning towards the lesion - with pathological formations in the cerebellar-pontine angle.

If the operations are intracranial, the head is placed on a stand with a recess or fixed with special holders for the bones (stereotaxic apparatus). The latter is important in the case of long-term microneurosurgical interventions.

The head end is raised by 15-30 to improve venous outflow from the brain. When approaching the formations at the bottom of the anterior cranial fossa and in the region of the pituitary gland, the head is somewhat thrown back. In this case, the frontal lobes of the brain are less injured and better raised.

Surgical accesses.

Proper surgical access for various surgical interventions determines the exact pathological process and often the outcome of the entire operation.

Surgical access consists of:

1) the correct incision of the soft tissues of the scalp;

2) accurate trepanation of the skull.

According to localization, accesses can be divided into types:

Exposing the surface of the cerebral hemisphere;

Opening access to the base of the brain;

Exposing the midline and medial parts of the hemispheres;

In order to expose the temporal lobe.

To mark the skin incision and trepanation, it is necessary:

Know the exact location of the pathological process;

Know the location and course of nerves, vessels in soft tissues and

Make a good exposure and review of the required area of the brain;

Create favorable conditions for wound closure and healing.

The size of the skin incision is determined by the size of the trepanation. Sometimes the skin incision is immediately made small, and then enlarged during the operation. For example, when emptying intracranial hematomas, two burr holes are first applied, then, if necessary, they switch to craniotomy. Difficulties in accessing formations located at the base of the skull are due to the need for low trepanation and skin incision, which extend to the front of the skull and neck.

The cosmetic effect should also be taken into account. Particularly undesirable cuts in the frontal and facial areas. When entering the base of the frontal and temporal regions, one should try not to damage the branches of the facial nerve and the superficial temporal artery, which will lead to bleeding during the operation, trophic skin disorders after the operation.

premedication and anesthesia.

The introduction of 4 mg of dexamethasone every 6 hours for 24-48 hours before surgery partially improves the neurological status of a patient with intracranial tumors, reducing cerebral edema, which occurs during surgical manipulations on the brain. The most convenient endotracheal intubation with hyperventilation and hypotension. Reducing intracranial pressure to facilitate manipulation of the brain is achieved by the introduction of mannitol, urea or Lasex, as discussed above.

Operation.

The head is shaved, washed, lubricated with gasoline and alcohol, 5-10% iodine tincture (in persons with delicate skin, you can limit yourself to alcohol only).

The site of the skin incision and trepanation is marked with ink or methylene blue according to the Cronlein scheme or its modifications. Local anesthesia is performed with a 0.25-5% solution of novocaine with adrenaline, blocking r.medialis et r.lateralis n.frontalis, r.zygomatico-temporalis et n.auriculo-temporalis during operations on the anterior sections of the skull and n.occipitalis major et minor during operations on the back of the skull. Then, infiltrative anesthesia is performed along the incision line with a 0.5% novocaine solution.

The skin incision is made not immediately for the entire length, but in separate sections, trying to remember the cosmetic nature of the incision.

In the subcutaneous tissue of the skull there is an abundant vascular network formed by branches of the main arterial trunks and a large number of anastomoses between the vessels of the same and opposite halves of the skull. The connective tissue bridges located between the fatty lumps of the subcutaneous tissue grow together with the adventitia of the vessels, therefore, when the skin and subcutaneous tissue are cut, their gaps gape and bleeding can be significant. To prevent bleeding, the surgeon with the fingers of the left hand, and the assistant with all the others, exert strong pressure on the skin on both sides of the intended skin incision line. At this time, the operator cuts the skin, subcutaneous tissue and galea aponeurotica with a scalpel, and the assistant sucks blood and novocaine solution from the incision with an aspirator.

After the dissection of galea aponeurotica, the skin becomes mobile, the edges of the wound move apart freely and hemostasis becomes very easy to carry out. With the weakening of pressure on the skin on one side, droplets of blood appear from gaping vessels on a white background. Hemostatic clamps are applied to them, clips, which are removed before suturing, or they are simply coagulated.

With horseshoe-shaped incisions after dissection of the skin, subcutaneous tissue and galea aponeurotica, the formed skin-aponeurotic flap is relatively easily separated from the subgaleal tissue, and in the temporal regions - from the fascia of the temporal muscle. The aponeurotic skin flap is turned away and a gauze roller 2.5-3 cm thick is placed under it. The roller compresses the blood vessels at the base of the flap to some extent, and the bleeding almost completely stops.

Light incisions separate the skin-aponeurotic sections from the periphery of the wound, which facilitates layer-by-layer suturing of the wound at the end of the operation. After that, the subgaleal tissue, the temporal muscle (in the corresponding area), and the periosteum are dissected in a horseshoe-like manner with the base downwards. The bone is skeletonized with a raspator along the entire length of the incision to a width of 1 cm, then the wound is moved apart with hooks and burr holes are applied.

During resection trepanation, the flap from the periosteum is peeled off over the entire area. One burr hole is applied and then the hole in the bone is expanded with these nippers to the required size.

During osteoplastic trepanation, burr holes are applied at a distance of 6-7 cm between them with a Doyen manual rotator or using a special machine with a cutting drill. A massive spear-shaped tip with a wide bell and large cutters should be used. With a spoon, free or relatively free fragments of the internal bone plate are removed from the bottom of the burr hole. Then a narrow elastic metal conductor is passed between the bone and the dura mater with a wire saw. If the conductor does not lead out into the second hole, it can be lifted up using a narrow elevator. The last cut is not completed to the end, so that a leg is obtained from the periosteum and muscle. When sawing the bone under the muscle flap, care must be taken to ensure that the file does not damage the muscle covering the bone. If necessary, you can partially remove the bone along the lower edge of the trepanation with pliers. The bone flap is lifted with an elevator, its possible adhesions to the hard shell are separated, then the flap is folded back, while the elevators can be used as levers.

When an osteoplastic flap is formed in the parasagittal region, one should move away from the line of the longitudinal sinus by 1-1.5 cm from the medial side. Pachyon granulations are often found in the region of this sinus, which begin to bleed when the dura mater is moved away from the bone with the help of a conductor. After the flap is folded back from the pachyon granulations and veins of the dura mater, it is easily stopped by a temporary tamponade, 5-6 minutes after pressing the bleeding area with a narrow tampon, the bleeding stops. In case of bleeding from the sinus, sutures are placed on its walls, the sinus is sutured and tied up above or below the site of its damage, and the area of damage is repaired with a venous graft. Bleeding from the bone is stopped with wax.

Depending on the operation plan, the incisions of the dura mater can be patchwork, linear, horseshoe-shaped, cruciform and other shapes. With a significant blood supply to the dura mater, the following techniques are usually used to ensure hemostasis at autopsy:

1) large vessels either preliminarily ligate or clip the main trunk (sometimes two) of the arterial trunk at the base of the flap, or at the time of the membrane incision, systematic clipping of all transected blood vessels is performed;

2) small vessels simply coagulate.

With a sharp tension of the dura mater due to high intracranial pressure, there is a great danger of developing acute prolapse of the brain and its infringement in the membrane defect. Reducing intracranial pressure is achieved by transfusion of mannitol, urea, lazeks during surgery before opening or extracting 30-50 ml of CSF by lumbar puncture.

To open the dura mater, its surface layer is lifted with the end of a scalpel, grasped with ophthalmic surgical tweezers, incised, the meningal spatula is advanced, and the membrane is further dissected along it. In the absence of a spatula, blunt scissors are inserted into the hole and further dissection is continued with their help. When moving the scissors forward, the branches lift the shell up with some effort, which prevents damage to the cerebral cortex.

At the end of the operation, it is necessary to restore the integrity of the skull and soft integuments of the skull and, first of all, ensure the tightness of the subarachnoid space in order to avoid liquorrhea and secondary meningitis. Before closing the dura mater, it is necessary to make sure that hemostasis is thorough at the initial arterial pressure. The anesthesiologist may apply pressure to the jugular veins in the neck to make sure there are no veins that have been opened. In those cases when, after the main stage of surgical intervention, there are indications for decompression, the dura mater flaps are freely placed on the brain without suturing, the membrane defect is covered with a fibrin film, the bone flap is removed and the tightness of the subarachnoid space is restored by carefully suturing the subaponeurotic tissue, muscle, periosteum . They are usually sutured in one layer with frequent interrupted or continuous silk sutures, then the sutures are applied to the skin along with galea aponeurotica. If it cannot be sutured due to protrusion of the brain, massive dehydration of the brain, lumbar puncture, and plastic surgery of skull defects are performed.

To prevent blood from accumulating in the epidural space, the ends of one of the sutures of the dura mater (in the center of the burr hole) are not cut off, but are passed through a hole made in advance with a drill in the bone flap above this suture. The ends of the thread are pulled up and clipped over the bone.

If, after additional expansion of the burr hole by biting at the end of the operation, it turns out that the bone flap is not firmly fixed enough and it may sink, the flap is sewn to the edges of the bone using several silk or metal sutures passed through specially prepared holes in the bone.

FEATURES OF OPENING THE POSTERIOR CRANIAL FOSTER.

TREPANATION METHODS.

Cushing's crossbow cut was proposed in 1905. In the future, it became widespread and served as the basis for a number of modifications.

This method has the following features:

1) the burr hole is located under a powerful layer of the occipital muscles, which, with sufficient decompression, prevents bulging;

2) wide removal of the occipital bone and the posterior arch of the atlas prevents the cerebellum from "wedging" into the foramen magnum and compressing the medulla oblongata;

3) ventricular puncture is used to reduce intracranial pressure and venous congestion in the posterior cranial fossa.

Horseshoe cut. In 1922, Dandy proposed replacing the crossbow incision with a horseshoe incision, also providing wide access to the posterior cranial fossa, but without a second median incision.

Kron and Penfield method. Otherwise, this method is called myoplastic suboccipital craniotomy and can be used for both bilateral and unilateral opening of the posterior cranial fossa. Soft tissues are usually separated along the entire occipital bone, even in cases where they are limited to the removal of bone over one hemisphere of the cerebellum.

Median cut. Described in 1926 by Frazier and Towne and then in 1928 by Naffziger. The median incision is much less traumatic than the crossbow and horseshoe incision, and wound closure is easier with it. In children of early and preschool age, in whom the muscular-aponeurotic cervical-occipital layer is thin and the occipital bone is more vertical, the median incision allows a more complete examination of both hemispheres of the cerebellum and other parts of the posterior cranial fossa. Access is facilitated if, with a linear skin incision, a partial transverse section of the muscle layer in the form of the letter T is added. If you are sure of the median localization of the tumor, the median incision can be used in young people with a thin and long neck and a narrow occiput.

The lateral vertical incision was proposed in 1941 by Adson to remove tumors of the cerebellopontine angle, which is carried out in a vertical direction at a distance of 3 cm away from the median plane, approximately midway between the midline and the mastoid process. This approach has become widespread in the removal of tumors of the auditory nerve.

TECHNIQUE OF THE OPERATION.

Position of the patient on the operating table.

The patient is usually placed face down. The position on the side is indicated when it is impossible to lay the patient face down and in cases where breathing can be expected to stop. Some surgeons prefer the lateral position when a good view of the upper fourth ventricle is needed. The sitting position creates favorable conditions for reducing venous bleeding.

Anesthesia.

Endotracheal intubation with hyperventilation and hypotension. When indications for local anesthesia begin with the blockade of nn. occipitalis in the area of their exit on both sides, and then perform infiltration anesthesia of the incision area.

In the presence of clinical signs of occlusive hydrocephalus with increased intracranial pressure, usually before opening the posterior cranial fossa, a ventricular puncture of the posterior horn of the lateral ventricle is performed with the extraction of 20-50 ml of cerebrospinal fluid, which reduces intracranial pressure and reduces bleeding of dissected tissues. If during surgery significant blood filling of soft tissues and bones or a sharp tension of the dura mater is detected, a repeated ventricular puncture is performed. Liquor overflowing the lateral ventricle is usually poured out under considerable pressure, after which the bleeding from the wound decreases, and the tension of the dura mater at the same time weakens.

Operation.

When trepanning the posterior cranial fossa with a Cushing crossbow incision, the arcuate part of the incision connects the bases of both mastoid processes and is directed upwards with a convexity. The center of the arc passes 3-4 cm above the external occipital protuberance. The vertical part of the incision runs from the midline to the spinous process of the fifth cervical vertebra. First, an arcuate incision is made in the skin, subcutaneous tissue and galea aponeurotica, the skin flap is separated to a level slightly below the external occipital protuberance, then a median incision is made along the entire intended line; the aponeurosis is dissected strictly along the midline, starting below the external occipital protuberance. Then the muscle layers are dissected to the scales of the occipital bone and the spinous processes of the upper cervical vertebrae. A transverse incision through the aponeurosis and muscle layers is carried out to the sides, starting from the upper point of the median incision of the aponeurosis. Attention is paid to preserving the area of muscles and aponeurosis at the point of their attachment to the superior nuchal line of the occipital bone. Otherwise, when suturing the aponeurosis-muscular layer, a powerful

the layer of the occipital muscles cannot be firmly fixed on the occipital bone. The muscle flaps are separated with a raspator downwards and to the sides, exposing the lower half of the scales of the occipital bone, the adjacent sections of the mastoid processes and the posterior edge of the occipital foramen.

The cutter imposes two holes in the bone in the area of the projection of the hemisphere of the cerebellum, then expanding them with wire cutters. If it is necessary to widely expose the posterior cranial fossa, the burr hole is expanded until a transverse sinus appears, which appears as a thick blue cord. The confluence of the sinuses should not be exposed, so a small visor is left here. In the lateral sections, the bone is removed, somewhat short of the opening of the mastoid vein and the mastoid process. The posterior edge of the foramen magnum is removed for 3-4 cm. The atlas is resected in cases where the pathological process causes an increase in intracranial pressure and a threat of compression of the medulla oblongata. Muscles attached to the arch of the atlas are cut off. With a small raspator, the periosteum with soft tissues is separated from the arch of the atlas for 3 cm and the arch is bitten along the same length. Removing it over a longer distance can lead to injury to the vertebral artery passing in the posterior atlanto-occipital membrane.

Craniotomy is a very complex neurosurgical operation, due to the removal of a piece of bone in a limited area of the skull. It is used to create a surgical approach to remove intracranial hematomas, various neoplasms, remove damaged structures in case of skull injuries and as a palliative treatment for increased intracranial pressure.

Story

This operation has been known since ancient times. Previously, trepanation was performed on people with inadequate behavior. The healers of that time believed that their illness was due to the influence of evil spirits locked in the skull of the patient, and if a “hole” was drilled in the bone, they would come out. Evidence of the antiquity of the operation was found even in prehistoric human remains from the Neolithic. When analyzing the rock paintings, it can be concluded that cavemen practiced trepanation to treat epileptic seizures, migraines and mental disorders. Then the removed section of the bone was kept by prehistoric people as a talisman that protects from evil spirits.

It is clear that earlier the ancient man did not know about antiseptics, antibiotics and other methods of fighting infection, so the frequency of purulent complications and subsequent death of the patient was extremely high. At present, special tools for craniotomy have been developed, which allow for more efficient manipulation and avoid undesirable complications.

The essence of the technique

At its core, trepanation, or craniotomy, is a surgical intervention, the meaning of which is to form a hole in the skull to create a surgical access if it is necessary to manipulate other structures of the cranium, or for a therapeutic purpose (elimination of hypertension during hemorrhage).

Craniotomy can be performed both in a planned and urgent manner. In the first case, these are, as a rule, brain tumors that do not pose a threat to the patient's life at the moment. In an urgent order, patients who have survived an accident, trauma, catastrophe, which led to a violation of the configuration of the skull and compression of brain structures, are operated on. In this case, the operation must be performed immediately, because there is a direct threat to life and health. The operation is quite voluminous, there is a risk of damage to the brain and blood vessels, so an experienced neurosurgeon should perform it.

Trepanation has clear indications for performance, and contraindications, as a rule, are relative, since the threat to life from damage to brain structures is more important than the risk of expected complications. The operation is not indicated for carrying out in severe conditions incompatible with life (severe form of shock, sepsis), due to the fact that surgical intervention can aggravate the patient's condition.

Indications for surgery

Due to the emergence of new conservative treatment methods, the number of indications for craniotomy is gradually decreasing, but this surgical intervention is still relevant in many serious conditions.

There are several types of trepanations that differ in indications and technique.

Decompression trepanation of the skull or (DCT) is performed to reduce intracranial pressure. Intracranial hypertension is the most common cause of death in young patients with severe traumatic brain injury. In emergencies, decompression craniotomy is the most preferred way to eliminate the threat to the life of the patient, especially if conservative methods for reducing intracranial pressure have not had the desired effect. Most often, such patients die due to the displacement of the brain structures relative to their normal position, and the wedging of the medulla oblongata into the foramen magnum. This condition leads to inevitable death, because in the medulla oblongata there are the most important vascular and respiratory centers responsible for the vital functions of the body. Intracranial hypertension can lead to:

neoplasms of large size;
intracranial abscesses (a cavity filled with pus);
injuries due to which a fragment of bone began to put pressure on the brain. Also, due to damaging factors, a hematoma and / or hemorrhage may form;
brain stroke.

After a stroke, which is hemorrhagic in nature, bleeding occurs, which is sometimes so intense that a hematoma begins to form, compressing the structures of the brain.

Trepanation for stroke and other conditions listed above is palliative in nature, i.e. it does not treat the underlying disease, but it allows you to eliminate intracranial hypertension and prevent herniation of the medulla oblongata.

Osteoplastic trepanation (KPT) is the initial stage to the main treatment of the disease. To create an operative access to the structures of the intracranial box, the doctor needs to remove a bone fragment. This will allow you to perform manipulations on the vessels and directly on the brain. Indications for its implementation are:

It can be seen that intracranial hematoma is an indication for two types of trepanations. If the localization and nature of the hematoma make it possible to remove the source of bleeding and restore the integrity of the structures of the intracranial box, then osteoplastic craniotomy is used. If this is not possible, then decompression is recommended to reduce intracranial pressure.

Preoperative period

The preoperative period plays an important role in the success of the operation. If the patient is shown a planned trepanation of the skull, then it is necessary to perform a number of instrumental studies, with the help of which it is possible to visualize the problem area and develop the tactics of the operation. It is also recommended to consult with other specialists (neuropathologist, therapist) to assess the general condition of the body and diagnose concomitant diseases that can cause complications during manipulation.

It must be said that very often patients come to the operating chair in an urgent manner, when minutes are counted, and additional examinations can cost the patient's life. The minimum diagnostic studies for urgent operations should include: MRI / CT, complete blood count, biochemical blood test and coagulogram.

Decompression (resection) trepanation

Resection trepanation of the skull is performed to eliminate intracranial hypertension. As a rule, this type of trepanation is carried out in the region of the temporal bone. The surgeon's instrumentation includes a scalpel for cutting soft tissues, a hand-held brace, and a wire saw. In this area, the bone hole will be closed by a large temporalis muscle, which will prevent additional damage to the brain. In addition, this localization is more acceptable for patients from a cosmetic point of view, since the postoperative scar will be hidden by hair.

At the first stage of the operation, surgeons cut out a skin flap linearly or in the form of a horseshoe, turning it outward. Then the temporal muscle is dissected along the direction of the fibers and the periosteum is incised. With the help of a hand rotator, several holes are made on the skull, through which a wire file is then passed. The holes are then "connected" together, and the bone fragment is successfully removed. During such manipulations, an operational opening with a diameter of 5 to 10 cm is formed.

After resection of a section of the bone, the doctor examines the dura mater. In the presence of high intracranial pressure, dissection of the dura mater can threaten the life of the patient due to the subsequent sharp change in the configuration of the brain. For this reason, it is first necessary to perform a lumbar puncture on the patient to reduce the volume of circulating cerebrospinal fluid, and then dissect the duramater.

At the final stage, sequential suturing of all soft tissues is performed, except for the dura mater. The bone fragment cannot be restored, but later the trepanation window is closed with synthetic materials.

Osteoplastic trepanation

Unlike decompression trepanation, in this case there is no typical localization for the removal of a bone fragment. The hole is made in that part of the skull in which the path to the pathological formation will be the shortest. At the first stage, the dissection of soft tissues is also performed. The skin flap is best incised in a horseshoe shape, so that later it can be easily sutured back.

At the next stage, the surgeon creates a bone-periosteal flap. Here, too, a neurosurgeon drills holes in the skull, between which sections of the bone are subsequently cut out using a special saw. Since at the final stage it will be planned to restore the bone area, one “jumper” is not sawn off, but broken, so as not to damage the periosteum that feeds the bone.

After that, the surgeon makes a dissection of the duramater and enters the cranial cavity, where he performs all the necessary manipulations. When the main operation is completed, all tissues are sutured in reverse order.

Postoperative period

After the operation, the patient is transferred to the intensive care unit under the supervision of resuscitators. During the day, the patient's condition is carefully monitored, because there is a certain risk of developing postoperative complications. If the patient is stable, then he is transferred to a regular ward of the neurosurgical department. It is very important for the medical staff to monitor the condition of the drains, since the appearance of purulent or profuse bloody discharge indicates the development of early complications.

Since craniotomy is an invasive operation performed near the brain, there is a high probability of developing all sorts of consequences. Postoperative complications can be divided into early and late. Early ones include:

impaired motor and sensory function;
intellectual disorders;
meningitis;
encephalitis;
convulsive syndrome;
damage to blood vessels and the formation of secondary hematomas;
seam failure.

After a stroke, complete or partial paralysis may develop, but this is a complication of the underlying disease, not surgery.

Long-term effects of the operation include:

skull deformity;
formation of a keloid scar;
headache, dizziness;
memory impairment, fatigue.

It must be said that in most cases, long-term consequences are not caused by the operation, but directly by the pathology of the brain.

Recovery of patients at the postoperative stage should include the use of pharmacological drugs, as well as psychological and social correction. Many patients after craniotomy are assigned a disability group, but this depends on the severity of neurological disorders and on the degree of disability of the patient.

18+ Video may contain shocking material!

When a craniotomy is performed, the consequences after the operation can be significant and long-lasting. The operation on the brain itself is already a complex neurosurgical process associated with the connection of blood vessels and nerve tissues; and at the same time, the surgical intervention itself leaves noticeable traces that require a recovery period.

Craniotomy: consequences after surgery is a very important problem that can affect many internal organs, as well as the functioning of the senses. The severity of complications primarily depends on the pathology that required intervention. Naturally, the postoperative period is very different in the elimination of the tumor and the elimination of traumatic brain injury, but there are also common problems after the operation.

The essence of trepanation of the skull

A craniotomy is an operation on the head. which consists in opening the skull in a limited area to eliminate the pathology or restore the affected tissues and blood vessels. Such operations are performed to eliminate hematomas, brain tumors, with craniocerebral injuries and skull fractures, hemorrhages with excessive intracranial pressure.

Trepanation is carried out in two main ways - resection and osteoplastic surgery. With the resection method, a hole of the required size is formed in the cranial bone by biting out with forceps, which is most often carried out during emergency surgical intervention. After such exposure, a bone defect remains, which, if necessary, is covered with artificial plates - plastic or metal.

The osteoplastic method includes cutting out tissue and bone flaps, and after the completion of the operation, returning them to their place with fixing with a suture to the periosteum. Cutting is done with a wire saw or pneumoturbine; in this case, the bone is sawn at an angle of 45 degrees, so that when the skull is restored, the bone flap does not fall inward.

Early postoperative period

To exclude a hematoma, graduates in the form of rubber tubes are brought under the flaps, the ends of which remain under a protective bandage. Blood flows out through the tubes, soaking the bandage. With a significant wetting of the bandage, it does not change, and a new bandage is wound additionally from above. If at the end of the operation the meninges are not completely sealed, then traces of cerebrospinal fluid may appear in the leaking blood mass.

The outlet tubes are usually removed one day after the completion of the surgery. To prevent leakage of cerebrospinal fluid and eliminate the risk of infection through the areas where the graduates were placed, provisional or additional sutures are placed and tied.

On the first day after the operation, it is necessary to control the condition of the bandage in the trepanation area. A significant swelling of the bandages over the operated area is due to postoperative hematoma, which can cause a rapid increase in swelling of the soft tissues of the forehead and eyelids, bleeding in the eye sockets. A very dangerous consequence that manifests itself at an early stage after craniotomy can be secondary liquorrhea, which can provoke infection of the cranial contents, causing meningitis and encephalitis. In this regard, it is extremely important to detect the presence of a clear liquid in the blood mass impregnating the bandage in a timely manner and take urgent measures.

Complications after craniotomy

Craniotomy sometimes becomes the only way to save a person's life, but carried out out of necessity, it leaves a severe injury that can cause very dangerous consequences. These possible complications include: bleeding, infection, swelling, brain tissue disorders that can cause memory, speech and vision impairments; balance problems, convulsions, weakness and paralysis, bowel and urination disorders. The operation is performed under general anesthesia, which, in turn, can cause a reaction to the anesthetic drug: dizziness, respiratory failure, low blood pressure, cardiovascular problems.

Infectious complication

After surgery on the skull, the likelihood of developing a number of infections increases significantly, and infection of the brain tissues itself occurs much less frequently, which is associated with appropriate sterilization of the area undergoing surgical treatment.

To a greater extent, the risk of infection threatens the lungs, intestines and bladder, the functions of which are regulated by brain regions. In many ways, this circumstance is associated with forced restrictions on human mobility and lifestyle changes after surgery. Prevention of such complications is exercise therapy, diet, sleep. Infections are treated with medication - the appointment of appropriate antibiotics.

Thrombi and blood clots

Pathologies in the brain and immobility after surgery can cause such a complication as the appearance of blood clots that cause blood clots in the veins of the legs. Broken blood clots are able to migrate through the veins and reach the lungs, which leads to the development of pulmonary embolism. This disease leads to very serious consequences, even death. For the prevention of pathology, it is necessary to introduce gymnastic exercises and quickly return to a normal lifestyle. On the recommendation of a doctor, foot compresses are applied and blood thinners are prescribed.

Neurological disorders

A temporary neurological disorder occurs when, after a craniotomy and surgery, swelling of adjacent brain tissues appears. Such anomalies cause various neurological symptoms, but after a certain time they disappear on their own. However, to accelerate tissue repair and relieve swelling, steroid drugs are prescribed - decadron and pridnisone.

With serious tissue damage during trepanation, long-term neurological pathologies can be observed. Such violations are expressed by various signs, depending on the localization of the damaged areas. These complications can only be prevented by the surgeon during the operation, minimizing the possibility of injury.

Bleeding

Bleeding in the area of trepanation is a fairly common occurrence resulting from damage to blood vessels.

Most often, active blood seepage occurs on the first day after surgery, and it is eliminated by drainage, which eliminates the accumulation of blood mass.

In exceptional cases, with heavy bleeding, a second operation is performed.

Craniotomy can cause convulsive phenomena when blood enters the brain tissue. To exclude this dangerous phenomenon, anticonvulsants are administered to the patient before the operation.

Frequent consequences of trepanation

Such a complex operation as craniotomy rarely goes without complications and certain consequences.

The severity of the consequences depends on the cause of the operation, the age of the patient, and the general state of his health.

The following consequences are most often manifested: deterioration in hearing or vision, deformation of the excised area of the skull, frequent headaches. To treat the consequences, long-term restorative drug therapy is carried out. The operation to eliminate the defect of the skull is extremely rare and only at a young age.

Postoperative rehabilitation

After craniotomy, a number of rehabilitation requirements must be observed: hygiene of the affected area, but without wetting it for a long time; exclusion of physical stress on the head (especially head tilts); performing therapeutic exercises to exclude stagnant processes; prescribing medicines and herbal medicines.

It is necessary to take blood thinners and control cholesterol levels. Herbal preparations based on mordovnik, fragrant and dyeing bedstraw, nightshade are recognized as an effective remedy.

Brain tumor: operation, consequences

Brain tumors are a broad group of intracranial neoplasms, either benign or malignant. They arise due to the start of an abnormal uncontrolled process of cell division, which were originally normal. Also, brain cancer can occur due to the development of metastases of the primary tumor in another organ.

Benign tumor: has clear boundaries and is easily removed (with this brain tumor, surgery is possible if the neoplasm is localized in an accessible place), rarely recurs, does not metastasize; rarely give metastases, but can put pressure on them; life threatening; may develop into a malignant tumor.
Malignant tumor: life-threatening, grow rapidly and grow into neighboring tissues, give metastases.

Common location of brain cancer

The types and severity of symptoms of a brain tumor are determined by the part of the brain that is under pressure from the neoplasm. As the tumor grows, cerebral symptoms develop. The reason for this is circulatory disorders in the brain and increased intracranial pressure.

The most common cancerous growth is a tumor of the cerebellum of the brain - symptoms:

brain tumor photo

gait disturbance;

muscle weakness;

forced position of the head.

disorder of coordination of movements;
involuntary oscillatory horizontal eye movements of high frequency;
slow speech (the patient pronounces words in syllables);
damage to the cranial nerves;
damage to the pyramidal tracts (motor analyzers);
violation of the vestibular apparatus.

The second most common cancer is brainstem tumor, which can occur in both children and adults. The brain stem regulates many functions in the body, so a brain stem tumor is accompanied by a large number of symptoms. The manifestations of certain signs depend on the area in which the tumor grows.

Signs of a brain tumor:

strabismus develops;
asymmetry of the face and smile appears;
twitching of the eyeballs;
hearing loss;
muscle weakness in a specific part of the body;
unsteadiness of gait;
hand tremor;
unstable blood pressure;
decrease or complete absence of tactile and pain sensitivity.

With the development of the disease, the above symptoms will be more pronounced.
General symptoms of a brain tumor:

frequent headaches that are not stopped by analgesics and narcotic drugs;
dizziness;
constant vomiting does not depend on food intake;
mental disorders that manifest themselves in disorders of memory, thinking, perception, increased irritability, aggressiveness, apathy towards others and poor orientation in space;
epileptic seizures for no apparent reason (with the growth of the tumor, the frequency of seizures increases);
development of vision problems: the appearance of flies before the eyes and a decrease in visual acuity.

A brain tumor

In almost all types of cancer, brain tumor surgery is indicated to remove the neoplasm.

Cancers in newborns

Most often, children develop intracerebral tumors, while in most cases they develop in the cerebellum, III and IV ventricle, in the brain stem. Neonatal brain tumor has supratentorial cancers. A distinctive feature of tumors in children is their location: under the cerebellum with a predominant lesion of the structures of the posterior cranial fossa.
Signs of a brain tumor in children of the first year of life:

an increase in the circumference of the head with swelling and tension of the fontanelles;
divergence of cranial sutures;
increased excitability;
vomiting after morning and afternoon sleep;
decrease in the rate of growth of body weight;
lag in psychomotor and intellectual development;
swelling of the optic nerve;
convulsions;
focal symptoms, which depend on the location of the tumor in the brain.

Therapy of a brain tumor in newborns occurs mainly surgically. In cases where the tumor is located in the area of vital centers. In this situation, radiation therapy can help destroy the tumor.

Surgical method of removing a cancerous tumor

Recently, oncology surgery has made a powerful leap forward. Numerous modern developments have appeared, thanks to which operations on brain tumors have become less traumatic for the brain and surrounding healthy tissues.

Stereotaxis - the operation is carried out using a computer. This method makes it possible to access the site of tumor formation with high accuracy.
Ultrasonic aspirators - their action lies in the ultrasonic impact on the tumor with a special power. As a result of this, the cancerous neoplasm is destroyed, and its remains are sucked off by an aspirator.
Shunting - in surgery is used to restore impaired circulation of cerebrospinal fluid in the brain. Violation of the cerebrospinal fluid provokes an increase in intracranial pressure and hydrocephalus develops. Shunting relieves headaches, nausea, and other symptoms.

Craniotomy is an operative method in which the upper part of the skull is removed. Many small holes are made in the walls of the skull bones. A special wire saw is inserted through them, with the help of which the bone is cut between the holes. During the operation, the entire tumor or its largest part is removed.
The method of electrophysiological mapping of the cerebral cortex is used to remove cancer of the speech-motor zone, tumors of the ponto-cerebellar angle.

Brain cancer treatment in Israel

In Israel, all types of brain cancer are treated, including gliomas, astrocytomas, tumors of metastatic origin, etc. At the same time, in private clinics, the patient himself can choose the attending physician, for example, undergo surgery with the famous neurosurgeon Professor Zvi Ram, who performed more than 1000 craniotomy operations ( craniotomy), in which the patient was conscious. Such operations allow you to control and preserve important brain functions. After an awake craniotomy, patients fully recover within 24-48 hours. When performing such operations in Israel, there are no age restrictions: the local neurosurgeons operate on both children and elderly patients over 80 years old.

Leading Israeli neurosurgeon Zvi Ram

Awake craniotomy operations for brain cancer require considerable effort and experience from the operating team, and not every neurosurgeon can perform them. In recent years, Israeli doctors during such operations are trying to monitor not only the most important functions of the brain, but also those functions that are considered less important. However, the professional activity of the patient may depend on these functions. We are talking, for example, about the sense of rhythm among musicians or the mathematical abilities of representatives of technical specialties. Today, Israeli neurosurgeons manage to successfully preserve these functions.

Laser technique: A sterile high power laser beam cuts the tissue and coagulates the blood during the excision. And also the use of a laser eliminates the possibility of accidental spread of tumor cells to other tissues.
In addition, new generation cryoapparatuses are used, which allow controlling the process of defrosting - freezing of neoplasm foci.

Postoperative consequences

The consequences of brain tumor surgery depend on the location of the cancer and its degree of development. Timely diagnosis and the adequacy of the treatment method also play an important role in a successful cure. According to statistics, timely three-stage treatment, which began at an early stage of the disease, gives a chance for a five-year survival rate in 60-80% of patients. With untimely treatment and inoperability of the tumor, survival for five years in 30-40% of patients.

But regardless of the type of treatment, after surgery for a brain tumor, the consequences can be the most severe. In some cases, it is necessary to re-train the patient to speak, read, move, recognize loved ones and, in general, learn about the environment. For successful recovery, an important role is played by the psychological mood of the patient and his loved ones.

Rehabilitation after removal of a brain tumor

A brain tumor is a three-dimensional concept that includes various formations localized in the cranium. These include benign and malignant degeneration of tissues arising as a result of abnormal division of brain cells, blood or lymphatic vessels, meninges, nerves and glands. In this regard, rehabilitation after tumor removal will include a complex of various effects.

Tumors in the brain occur much less frequently than in other organs.

Classification

Brain tumors are of the following types:

benign tumors develop from the cells of the tissue in which they appear. As a rule, they do not grow into neighboring tissues (however, with a very slowly growing benign tumor, this is possible), they grow more slowly than malignant ones and do not metastasize.

Malignant tumors are formed from immature own cells of the brain and from cells of other organs (and metastases) carried by the blood stream. Such formations are characterized by rapid growth and germination into neighboring tissues with the destruction of their structure, as well as metastasis.

Clinical picture

The set of manifestations of the disease depends on the location and size of the lesion. It consists of cerebral and focal symptoms.

Cerebral symptoms

Any of the processes listed below is a consequence of compression of brain structures by a tumor and an increase in intracranial pressure.

Dizziness may be accompanied by horizontal nystagmus.
Headache: intense, constant, not relieved by analgesics. Appears due to increased intracranial pressure.
Nausea and vomiting, which does not bring relief to the patient, is also a consequence of increased intracranial pressure.

Focal symptoms

It is diverse, it depends on the localization of the tumor.

Movement disorders are manifested by the appearance of paralysis and paresis up to plegia. Depending on the lesion, either spastic or flaccid paralysis occurs.

Coordination disorders characteristic of changes in the cerebellum.

Sensitivity disorders are manifested by a decrease or loss of pain and tactile sensitivity, as well as a change in the perception of the position of one's own body in space.

Violation of oral and written speech. When the tumor is localized in the area of the brain responsible for speech, the patient's symptoms gradually increase, those around the patient notice a change in handwriting and speech, which become slurred. Over time, speech becomes slurred, and when writing, only scribbles appear.

Impaired vision and hearing. With damage to the optic nerve, the patient's visual acuity and the ability to recognize text and objects change. When the auditory nerve is involved in the pathological process, the patient's hearing acuity decreases, and if a certain part of the brain responsible for speech recognition is damaged, the ability to understand words is lost.

Convulsive syndrome. Episyndrome often accompanies brain tumors. This is due to the fact that the neoplasm compresses the structures of the brain, being a constant irritant of the cortex. This is precisely what provokes the development of a convulsive syndrome. Seizures can be tonic, clonic, and tonic-clonic. This manifestation of the disease is more common in young patients.

Autonomic disorders expressed by weakness, fatigue, instability of blood pressure and pulse.

Psycho-emotional instability manifested by impaired attention and memory. Often, patients change their character, they become irritable and impulsive.

Hormonal dysfunction appears with a neoplastic process in the hypothalamus and pituitary gland.

Diagnostics

The diagnosis is made after questioning the patient, examining him, conducting special neurological tests and a set of studies.

If a tumor in the brain is suspected, a diagnosis should be made. For this, research methods such as skull radiography, CT, MRI with contrast are used. If any formations are detected, it is necessary to conduct a histological examination of tissues, which will help to recognize the type of tumor and build an algorithm for the treatment and rehabilitation of the patient.

In addition, the condition of the fundus is checked and electroencephalography is performed.

Treatment

There are 3 approaches to the treatment of brain tumors:

Surgical manipulations.
Chemotherapy.
Radiation therapy, radiosurgery.

Surgery

Surgery in the presence of brain tumors is a priority measure if the neoplasm is delimited from other tissues.

Types of surgical interventions:

total removal of the tumor;
partial removal of the tumor;
two-stage intervention;
palliative surgery (relieving the patient's condition).

Contraindications for surgical treatment:

severe decompensation on the part of organs and systems;
germination of the tumor in the surrounding tissues;
multiple metastatic foci;
exhaustion of the patient.

Contraindications after surgery

After the operation is prohibited:

drinking alcohol for a long time;
air travel within 3 months;
active sports with a possible head injury (boxing, football, etc.) - 1 year;
bath;
running (it is better to walk fast, it trains the cardiovascular system more effectively and does not create an additional depreciation load);
sanatorium treatment (depending on climatic conditions);
sunbathing, ultraviolet irradiation, because it has a carcinogenic effect;
healing mud;
vitamins (especially group B).

Chemotherapy

This type of treatment involves the use of special groups of drugs, the action of which is aimed at the destruction of pathological fast-growing cells.

This type of therapy is used in conjunction with surgery.

Methods of administration of drugs:

directly into the tumor or into surrounding tissues;
oral;
intramuscular;
intravenous;
intra-arterial;
interstitial: into the cavity left after removal of the tumor;
intrathecal: into the cerebrospinal fluid.

Side effects of cytostatics:

The choice of a specific drug for treatment depends on the sensitivity of the tumor to it. That is why chemotherapy is usually prescribed after a histological examination of the tissues of the neoplasm, and the material is taken either after surgery or in a stereotaxic way.

Radiation therapy

It has been proven that malignant cells due to active metabolism are more sensitive to radiation than healthy ones. That is why one of the methods of treating brain tumors is the use of radioactive substances.

This treatment is used not only for malignant, but also for benign neoplasms in the case of a tumor located in areas of the brain that do not allow surgical intervention.

In addition, radiation therapy is used after surgical treatment to remove the remnants of neoplasms, for example, if the tumor has grown into the surrounding tissues.

Side effects of radiation therapy

hemorrhage in soft tissues;
burns of the skin of the head;
skin ulceration.

toxic effects on the body of decay products of tumor cells;
focal hair loss at the site of exposure;
pigmentation, redness or itching of the skin in the area of manipulation.

Radiosurgery

It is worth considering separately one of the methods of radiation therapy, which uses the Gamma Knife or Cyber Knife.

This method of treatment does not require general anesthesia and craniotomy. Gamma Knife is a high-frequency gamma irradiation with radioactive cobalt-60 from 201 emitters that are directed in one beam, the isocenter. In this case, healthy tissue is not damaged. The method of treatment is based on a direct destructive effect on the DNA of tumor cells, as well as on the growth of squamous cells in the vessels in the neoplasm. After gamma irradiation, the growth of the tumor and its blood supply stops. To achieve the desired result, one procedure is required, the duration of which can vary from one to several hours.

This method is characterized by high accuracy and minimal risk of complications. Gamma Knife is used only for diseases of the brain.

This effect also applies to radiosurgery. Cyberknife is a type of linear accelerator. In this case, the irradiation of the tumor occurs in different directions. This method is used for certain types of neoplasms for the treatment of tumors not only of the brain, but also of other localization, i.e., it is more versatile than the Gamma Knife.

Rehabilitation

It is very important to be constantly on the alert after the treatment of a brain tumor in order to detect a possible recurrence of the disease in time.

Purpose of rehabilitation

The most important thing is to achieve the maximum possible restoration of lost functions in the patient and his return to everyday and working life independent of others. Even if the full revival of functions is not possible, the primary goal is to adapt the patient to the limitations that have arisen in him in order to make his life much easier.

The rehabilitation process should begin as early as possible to prevent a person from becoming disabled.

Recovery is carried out by a multidisciplinary team, which includes a surgeon, a chemotherapist, a radiologist, a psychologist, an exercise therapy doctor, a physiotherapist, an exercise therapy instructor, a speech therapist, nurses and junior medical staff. Only a multidisciplinary approach will provide a comprehensive quality rehabilitation process.

Recovery takes an average of 3-4 months.

adaptation to the consequences of the operation and to a new way of life;
restoration of lost functions;
learning certain skills.

For each patient, a rehabilitation program is drawn up and short-term and long-term goals are set. Short-term goals are tasks that can be completed in a short period of time, for example, learning to sit up on your own in bed. Upon reaching this goal, a new one is set. The setting of short-term goals divides the long process of rehabilitation into certain stages, allowing the patient and doctors to assess the dynamics of the condition.

It must be remembered that the disease is a difficult period for the patient and his relatives, because the treatment of tumors is a difficult process that requires a lot of physical and mental strength. That is why it is not worth underestimating the role of a psychologist (neuropsychologist) in this pathology, and his professional help is needed, as a rule, not only for the patient, but also for relatives.

Physiotherapy

Exposure to physical factors after surgery is possible, treatment in this case is symptomatic.

In the presence of paresis, myostimulation is used. with pain and swelling - magnetotherapy. Phototherapy is also often used.

The possibility of using laser therapy in the postoperative period should be discussed by the attending physicians and rehabilitation specialists. However, do not forget that the laser is a powerful biostimulator. So it should be used with extreme caution.

With the development of paresis in the limbs, a massage is prescribed. When it is carried out, the blood supply to the muscles, the outflow of blood and lymph improves, the joint-muscular feeling and sensitivity, as well as neuromuscular conduction, increase.

Therapeutic exercise is used in the preoperative and postoperative periods.

Before surgery, with a relatively satisfactory condition of the patient, exercise therapy is used to increase muscle tone, train the cardiovascular and respiratory systems.
After surgery, exercise therapy is used to restore lost functions, form new conditioned reflex connections, and combat vestibular disorders.

In the first days after the operation, you can perform exercises in a passive mode. If possible, breathing exercises are performed to prevent complications associated with physical inactivity. In the absence of contraindications, you can expand the motor schedule and perform exercises in a passive-active mode.

After transferring the patient from the intensive care unit and stabilizing his condition, you can gradually verticalize him and focus on restoring lost movements.

In the absence of contraindications, it is possible to expand the motor regimen: transfer the patient to a standing position and begin to restore walking. Exercises with additional equipment are added to the therapeutic gymnastics complexes: balls, weights.

All exercises are performed to fatigue and without the occurrence of pain.

It is important to pay the patient's attention even to minimal improvements: the appearance of new movements, an increase in their amplitude and muscle strength. It is recommended to break the rehabilitation time into small intervals and set specific goals. Such a technique will allow the patient to be motivated and see their progress, since patients with the diagnosis in question are prone to depression and denial. Visible positive dynamics will help to realize that life is moving forward, and recovery is quite an achievable height.

2 COMMENTS

articles in general are very necessary and liked
but there are small errors

1 Physiotherapeutic treatment is based on the influence of not only natural factors on a living organism, but also preformed physical factors (physical factors - generated by physio equipment)
2 However, do not forget that the laser is a powerful biostimulator.
A very controversial postulate at low intensities, it penetrates rather shallowly, and at a wavelength of 630 nm (red) up to 3 mm into the skin. electromyostimulation more pronounced biostimulator

3 physiotherapy: quackery and reality I think a typo instead of and should be or
did not read other articles did not have time
4 it is desirable to have the surname of the author of the articles
sorry for those who disagree with my opinion

Associate Professor of the Department of Physiotherapy
Markarov Gavril Surenovich

As for laser therapy: 2. regarding the statement that the laser is a powerful biostimulator - the opinion is based not only on the personal experience of a specialist, but also on the conviction of such honored figures in medicine as Ushakov and Ponomarenko. This means not a stimulating effect on the neuromuscular apparatus, like electrical stimulation, but rather about catalysing reparative and regenerative processes in tissues.
Indeed, the red spectrum of the wave penetrates up to 3 mm, but infrared - up to 10 cm.

Craniotomy and hematoma surgery: consequences of surgery

Surgery trepanation of the skull for hematoma, strokes and removal of tumors

Stroke- this is a condition of the so-called "emergency pathological deviation", having discovered which, it is necessary to provide assistance as soon as possible, which includes not only the fight against symptoms, but often surgical intervention. Such an ailment very often needs a surgical method of treatment, because it is not always possible to eliminate the cause with drugs.

A stroke affects the vessels of the brain, which can lead to unforeseen consequences, including paralysis, problems with speech, breathing, and even death.

If a stroke caused a rupture of a vessel and a hemorrhage in the brain, only trepanation gives a chance to save the patient. Only by getting directly to the source of the problem, you can qualitatively solve it.

Trepanation is resorted to on the basis of such studies:

Duplex ultrasound of vessels;
CT or MRI;
Angiography.

These technologies enable doctors to make the correct diagnosis, determine the location, extent of the lesion, and make a prognosis for the patient.

With tumors in the brain, it is very difficult to do without surgical intervention, even if it is benign. The neoplasm tends to increase in size, which will cause pressure on one of the parts of the brain.

No one can say for sure which function the tumor will disrupt and whether the process is reversible.
Trepanation with a tumor in the brain - a very common procedure by which the skull is opened, and the doctor gets access to the formation and cuts it out, trying to bypass healthy tissue as much as possible.

Now more and more establishments are switching to laser treatments. in which it is not even necessary to open the skull. But unfortunately, few hospitals, especially public ones, can afford such equipment.

brain hematoma- This is a pathology caused by the accumulation of blood in a limited area in the cranial cavity. Hematomas are divided by type, localization, and size, but they are all associated with rupture of blood vessels and hemorrhages.

Trepanation in this case is necessary in order to pump out blood, find a problem area, and bring it into proper shape. Bleeding can be stopped in other ways, but it is impossible to eliminate the consequences of what has already happened without plunging into the cranial cavity.

Rehabilitation after trepanation

Rehabilitation after such a serious intervention is aimed at restoration of functions damaged area and to improve the general condition of the patient.

This part is the final, and, one might say, the most important. Without necessary measures after surgery

full recovery is not possible. Moreover, the affected person may return to the condition that caused the problem.

Rehabilitation after trepanation is complex, and is aimed at consolidating the result of the operation and at neutralizing all kinds of negative consequences.

The main tasks of the rehabilitation period:

Neutralization of the cause. what caused the brain disease after the operation;
Smoothing the consequences surgical intervention;
Early identification of risk factors. which can lead to complications;
Maximum Recovery impaired brain functions.

The recovery process after trepanation is the most complex, which is why it consists of many successive stages, each of which is equally important. The duration of treatment and the technique may differ in each case.

The duration and outcome of the operation is influenced by many factors, including:

The initial state of health of the patient;
Physician experience;
Patient's age;
The presence of complications and concomitant diseases.

The main thing to remember for those who have survived such an operation or have a relative who has undergone trepanation is that stress and noise are an absolute contraindication.

The patient should not be overloaded in the first ten days, up to the moment the sutures are removed.

After this stage, it is necessary to gradually introduce more active measures along with drug treatment.

In addition to ensuring complete rest, it is necessary to take a number of such sequential measures:

Choose painkillers. Pain causes additional tension, which brings the patient back into the risk zone;
Antiemetics are part of the treatment, because due to violations of certain functions and increased sensitivity and susceptibility, the patient may suffer from bouts of vomiting and headache;
Regular physical therapy required and testing of brain functions;
weeklyconsultations with a psychologist and a neurologist. This stage is important, as it allows you to detect the slightest changes in consciousness or behavior, which is a signal of violations;
Testing neural connections of the brain;
Permanentkeeping the wound clean. monitoring the healing and disinfection processes;
Preventive measures to prevent the development of complications.

After 14-20 days of stay in the hospital ward under strict supervision, the patient is discharged and sent for secondary rehabilitation on an outpatient basis.

The full range of restorative procedures consists of:

control wound conditions;
complex various physiotherapy procedures;
recovery lost or damaged skills;
occupational therapy and other approaches;
exercise therapy and massages;
walks outside the hospital buildings;
control diet and lifestyle;
psychotherapy.

In addition, the patient is prescribed medications. which help to cope with the disease and its consequences from the inside.

It is imperative for patients to constantly keep in touch with the doctor, who must be contacted at the slightest deviation from the norm, which may be:

physical and mental (failures of thinking, logic, memory, motor processes and reactions, sensations);
inflammation and swelling of scars;
the appearance of regular headaches;
nausea and vomiting;
difficulty breathing;
convulsions and fainting;
facial numbness;
general weakness, chills, fever;
blurred vision;
chest pain.

When starting rehabilitation, you need to remember that even the right approach may not lead to a complete recovery, but it will teach you how to live with the problem in a quality manner, and gradually improve your condition.

What are the consequences for children and adults

Asthenia- a constant feeling of fatigue, depression, sensitivity to atmospheric phenomena, insomnia, tearfulness;
Speech disorders– often occurs in both children and adults. It is difficult to immediately determine whether this phenomenon is temporary. So you just have to wait and watch;
Psychosis;
Forgetfulness ;
Paralysis ;
convulsions(more often in children);
loss of coordination(more pronounced in children);
Hydrocephalus(in children, less often in adults);
ZPR(in children).

Infectious complication

As after any surgical intervention, trepanation negatively affects the protective functions of the body, which increases the risk of infection.

brain infections- an extremely rare phenomenon, but the wound itself is easy to infect by poorly processing the instruments

for surgery or materials for dressings.

The lungs, intestines, and bladder suffer from infection. All of these organs are prone to catching infections in the first place.

After skull surgery rises the likelihood of developing a number of infections, and infection of the brain tissues itself occurs much less frequently, which is associated with appropriate sterilization of the site undergoing surgical exposure.

The highest risk of infection is lungs, intestines and bladder. functions of which are regulated by brain regions. In many ways, this circumstance is associated with forced restrictions on human mobility and lifestyle changes after surgery. Prevention of such complications is exercise therapy, diet, sleep. Infections are treated with medication - the appointment of appropriate antibiotics.

Thrombi and blood clots

Pathological processes and changes in the brain tissues, poor mobility in the postoperative period, can cause blood stasis, which causes the formation blood clots. Most often, the veins in the legs are affected.

If a blood clot breaks off, it can migrate through the body, settling in the lungs or heart. Very often, the detachment of a thrombus leads to lethal outcome. There are also cases of pulmonary thrombosis, which is a very dangerous consequence and requires immediate intervention. This disease leads to very serious consequences, even death.

The best prevention against clots is exercise, plenty of fresh air, and anticoagulants (blood thinners).

Neurological disorders

Temporary or permanent disorders of a neurological nature appear when, after a craniotomy, there is swelling of nearby brain tissue. All this leads to different kinds of consequences,

causing symptoms of seemingly unrelated diseases. But fortunately, if the operation was successful, everything is restored to its original state.

To speed up the healing process, prescribe steroidal anti-inflammatory drugs .

With more serious errors made during the operation, the pathologies may be longer. There are many causes of symptoms, and they all depend on more than one factor.

Bleeding

Bleeding- This is one of the most common phenomena after trepanation. Within a few days after the operation, the vessels may bleed. This problem is eliminated by drainage. Usually there is little blood and it does not cause problems.

But there are times when the bleeding is so profuse that you have to do repeated trepanation to stop it and prevent more serious consequences.

Blood that accumulates in the cranial cavity can touch motor centers or nerve endings. which causes convulsions. In order to avoid such manifestations during surgery, the patient should be given anticonvulsant drugs intravenously in advance.

Content

The operation was carried out in antiquity, BC. In the writings of the ancient Greek healer Hippocrates, it is described in detail. However, even in our time, this type of surgical intervention remains one of the most difficult and risky. For its implementation, serious evidence is required.

What is craniotomy

In medical terminology, the name is used in Latin - trepanatio, or in French - trépanation. This is a surgical operation in which the skull is opened in order to gain access to tumors, hematomas, and other formations inside the brain. Helps save a person's life by quickly reducing intracranial pressure. Surgery is performed under general anesthesia, during which the patient does not feel anything.

Why do craniotomy

The operation is performed only in cases where there is a serious danger to human life. In most cases, trepanation of the skull is performed with a hematoma and with dislocation of the brain. Other indications are:

inflammatory infectious processes in the brain;
craniocerebral wounds;
oncological formations;
consequences of hemorrhage after a stroke;
thrombus formation;
increased intracranial pressure;
problems with blood vessels;
obtaining brain tissue for biopsy.

Depending on the problem, trepanation is performed on one or both sides of the skull. According to the type of localization of the injury, operations are distinguished:

in the temporal region - temporal;
in the frontal part - frontal and bifrontal;
near the posterior cranial fossa - suboccipital trepanations.

Osteoplastic craniotomy

Different types of surgery help to get the desired result for each disease. More often than others, osteoplastic trepanation of the skull (t. cranii osteoplastica) is used. This method is called traditional. At the base of the skull, a horseshoe-shaped or oval incision is made at an angle, the bone is temporarily removed, and manipulations are performed on the brain. Bone tissue and skin are returned to their place.

Decompression craniotomy

In order to reduce high intracranial pressure in inoperable tumors, t. cranii decompressiva or decompression craniotomy. The technique was named "Cushing" after the surgeon who first made it. If the location of the tumor is known, then a trepanation window for decompression is made over it. If it is not possible to accurately determine, then a decompression incision is made in the region of the temporal bone in the form of a horseshoe turned down. Right-handers on the right side, and left-handers on the left. This is done so that there is no speech impairment.

Skull craniotomy

Cranioectomy, or craniotomy of the skull, is performed on the brain of a conscious patient, as with stereotaxy. The area of the scalp with nerve endings during surgical treatment is under local anesthesia. In addition, he receives special sedatives to reduce the feeling of fear. The doctor can observe the reaction of the operated. If necessary, he is given general anesthesia. If part of the removed bone cannot be returned to its place, it is replaced with an artificial one, or cranioplasty.

Resection trepanation of the skull

During such a type as resection trepanation of the skull (t. cranii resectionalis), the hole expands to the required incision. Manipulations are carried out on the brain, but the bone plate does not return back. A skin patch is placed over the incision site. After trepanation with resection, a person receives a serious defect if a wide hole was made. It not only does not look aesthetically pleasing, but also causes inconvenience to the patient - at any time, soft tissues can be damaged.

How is craniotomy done

Before opening the skull, the doctor prepares the patient for surgery. The patient must:

Stop taking blood-thinning medications for a week.
Stop smoking and drinking alcohol.
For a day, refuse to eat and drink.

All operational actions are performed in the sequence:

The patient is placed on the couch, the head is fixed.
Anesthesia is administered.
Shave the hair in the operated area.
Make an incision in the skin and separate it from the skull.
Small holes are drilled in the cranial vault with a drill, and the contour of the bone flap is rounded off with a file - Polenov's guide through the holes.
The cut part is removed.
The dura mater is removed.
The problem in the cranial cavity is eliminated. This part of the operation is the longest and can take several hours.
The bone flap is put in place and fixed with screws and titanium plates, if necessary, osteoplasty is performed.
The skin is placed on top and sewn on.

Rehabilitation after craniotomy

The first day after the end of the operation, the patient is in intensive care, connected to the devices. The next 3-7 days must pass in the hospital under the supervision of doctors. This period for recovery after craniotomy is very conditional, if a person has complications, it can increase. During the rehabilitation period, the patient is prescribed medications:

painkillers;
antibiotics - to prevent inflammation;
antiemetics;
sedatives;
anticonvulsants;
steroid drugs that remove excess water from the body.

The sterile bandage is removed from the wound in a day. The skin around the wound should be constantly processed, kept clean. After 2 days, the patient is allowed to get up and walk a little. After being discharged home, rehabilitation continues. The following conditions must be observed:

do not lift objects weighing more than 3 kg;
stop smoking;
exclude nervous unrest;
take a course with a speech therapist to restore speech;
lean as little as possible;
go on a diet prescribed by a doctor;
Take daily supervised short walks.

You should carefully monitor the emotional state of a person after surgery. Some people become prone to depression and nervous disorders. It is necessary to surround them with care and attention, to protect them from unnecessary unrest. If you can’t cope with anxiety on your own, you need to contact a psychologist.

Consequences of craniotomy

Even with the current level of development of medicine, the human brain remains the least explored area of the body. For this reason, such operations are carried out only as a last resort, when there is no other alternative. The operation can bring relief or lead to new complications. The patient is warned in advance that there may be consequences after craniotomy:

coma;
bleeding;
frequent headaches;
nausea and vomiting;
elevated temperature;
nervous disorders;
swelling;
hearing, vision, speech and memory impairments;
malfunction of the digestive and urinary systems;
convulsions;
paralysis of the limbs;
infections.

Disability after craniotomy

Many people are concerned about the question - do they give disability after a craniotomy. However, no doctor can answer in advance. If the operation is successful, when the patient quickly recovers and does without outside help, disability after craniotomy will not be given. If there are complications with which the patient cannot live a full life, he is sent to the medical commission. It consists of several competent specialists who determine the degree of violation of vital functions. When the condition improves, the disability group is removed.

Life after a craniotomy

Carrying out the manipulation, if it went without consequences, helps the patient to lead a normal life after a craniotomy. However, there are some restrictions that must be observed:

refuse to play sports;
regularly visit a medical facility to monitor the condition;
reduce the likelihood of recurrent hematomas.

Video: skull surgery

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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Craniotomy is an operation technique. Bilateral osteoplastic trepanation in the frontal region

Osteoplastic

Features of osteoplastic craniotomy

Resection trepanation

Osteoplastic craniotomy

Decompressive trepanation

Resection trepanation

Awake craniotomy

What are the consequences for children and adults

Infectious complication

Story

The essence of the technique

Indications for surgery

Preoperative period

Decompression (resection) trepanation

Osteoplastic trepanation

Postoperative period

The essence of trepanation of the skull

Early postoperative period

Complications after craniotomy

Infectious complication

Thrombi and blood clots

Neurological disorders

Bleeding

Frequent consequences of trepanation

Postoperative rehabilitation

Brain tumor: operation, consequences

Common location of brain cancer

Cancers in newborns

Surgical method of removing a cancerous tumor

Brain cancer treatment in Israel

Postoperative consequences

Rehabilitation after removal of a brain tumor

Classification

Clinical picture

Cerebral symptoms

Focal symptoms

Diagnostics

Treatment

Surgery

Contraindications after surgery

Chemotherapy

Radiation therapy

Side effects of radiation therapy

Radiosurgery

Rehabilitation

Purpose of rehabilitation

Physiotherapy

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Craniotomy and hematoma surgery: consequences of surgery

Surgery trepanation of the skull for hematoma, strokes and removal of tumors

Rehabilitation after trepanation

What are the consequences for children and adults

Infectious complication

Thrombi and blood clots

Neurological disorders

Bleeding

What is craniotomy

Why do craniotomy

Osteoplastic craniotomy

Decompression craniotomy

Skull craniotomy

Resection trepanation of the skull

How is craniotomy done

Rehabilitation after craniotomy

Consequences of craniotomy

Disability after craniotomy

Life after a craniotomy

Video: skull surgery