Craniotomy Procedure: Step-by-Step Guide, Indications & Postoperative Care

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Management of Craniotomy

Introduction

A craniotomy is a surgical procedure in which a portion of the skull is temporarily removed to access the brain. It is performed for conditions such as brain tumors, traumatic brain injury, intracranial hemorrhage, aneurysms, epilepsy, or brain infections. Proper management before and after craniotomy is crucial to reduce complications, promote neurological recovery, and improve patient outcomes.

Preoperative Management

Preoperative care focuses on patient preparation and risk reduction.

  • Assessment

    • Detailed neurological examination (level of consciousness, pupil reaction, motor power)

    • Baseline vital signs and Glasgow Coma Scale (GCS)

  • Investigations

    • CT/MRI brain, blood investigations, coagulation profile

  • Medications

    • Anticonvulsants to prevent seizures

    • Steroids to reduce cerebral edema

    • Antibiotics for infection prevention

  • Patient Preparation

    • Explain procedure to patient and family

    • Nil per oral (NPO) as advised

    • Shaving and skin preparation of surgical site

  • Psychological Support

    • Reduce anxiety and provide reassurance


Postoperative Management

Post-craniotomy care is critical and usually provided in ICU or neurosurgical ward.

1. Neurological Monitoring

  • Frequent assessment of:

    • Level of consciousness

    • Pupil size and reaction

    • Limb movement and strength

  • Monitor for signs of increased intracranial pressure (ICP):

    • Headache, vomiting, restlessness, altered sensorium

2. Positioning

  • Head elevation at 30 degrees to promote venous drainage

  • Maintain head and neck in neutral alignment

  • Avoid flexion or rotation of neck

Avoid flexion or rotation of neck

3. Vital Signs Monitoring

  • Monitor blood pressure, pulse, respiration, oxygen saturation, and temperature

  • Prevent hypertension which may increase ICP or cause bleeding

4. Wound and Drain Care

  • Observe surgical site for bleeding, swelling, redness, or CSF leakage

  • Maintain aseptic technique during dressing changes

  • Monitor output from surgical drains

5. Fluid and Electrolyte Balance

  • Strict input and output charting

  • Monitor for diabetes insipidus or SIADH

  • Maintain adequate hydration without fluid overload

6. Pain Management

  • Administer prescribed analgesics

  • Avoid over-sedation as it interferes with neurological assessment

7. Seizure Prevention

  • Continue anticonvulsant therapy as prescribed

  • Maintain safety precautions (side rails, oxygen ready)

8. Infection Prevention

  • Maintain strict aseptic care

  • Monitor temperature and white blood cell count

  • Administer antibiotics as ordered

Complications to Watch For

  • Increased intracranial pressure

  • Hemorrhage

  • Infection (meningitis, wound infection)

  • Seizures

  • Cerebrospinal fluid (CSF) leakage

  • Neurological deficits

Rehabilitation and Long-Term Care

  • Early mobilization as advised

  • Physiotherapy and speech therapy if needed

  • Nutritional support

  • Patient and family education on:

    • Medication compliance

    • Warning signs (severe headache, vomiting, seizures)

    • Follow-up visits

Conclusion

Effective management of craniotomy requires a multidisciplinary approach involving surgeons, nurses, and rehabilitation teams. Careful neurological monitoring, prevention of complications, and patient-centered care play a key role in recovery and improving quality of life after surgery.


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