Our Summary

This research paper discusses a surgical procedure called “emergent craniotomy” which is used for serious head injuries, especially in rural and regional settings. This method, first presented by Kenneth G. Jamieson in 1965, has been used successfully in smaller hospitals before transferring patients to larger, urban trauma centers. Although performing this procedure can be intimidating for those who are not specialized in brain surgery, the authors argue that continuous education can help non-brain surgeons perform this life-saving procedure. The paper presents a simplified, 10-step guide on how to perform this operation, considering that rural hospitals may not have access to the same resources as urban ones. The authors also suggest that future surgeries could be performed remotely with supervision from a neurosurgeon via tele-surgery.

FAQs

  1. What is an “emergent craniotomy” and when is it used?
  2. Who first presented the method of emergent craniotomy and when?
  3. How can non-brain surgeons be trained to perform this procedure effectively?

Doctor’s Tip

A helpful tip a doctor might tell a patient about craniotomy is to follow all pre-operative instructions carefully, including fasting before the surgery and avoiding certain medications. It is also important to discuss any concerns or questions with your healthcare team and to follow all post-operative care instructions for a successful recovery.

Suitable For

Patients who are typically recommended for a craniotomy include those with traumatic brain injuries, brain tumors, intracranial hemorrhages, aneurysms, arteriovenous malformations, and other conditions that require surgical intervention within the skull. Craniotomies are often recommended for patients who have failed conservative management or have a high risk of neurological deterioration without surgical intervention. Additionally, patients who are stable enough to undergo surgery and have a good prognosis are usually considered for a craniotomy.

Timeline

Before Craniotomy:

  1. Patient experiences a traumatic head injury.
  2. Patient is evaluated by medical professionals to determine the severity of the injury.
  3. Imaging tests such as CT scans or MRIs are conducted to assess the extent of the damage.
  4. Neurosurgeon recommends a craniotomy as a treatment option.
  5. Patient undergoes preoperative preparations, including blood tests, anesthesia consultation, and instructions on fasting.

During Craniotomy:

  1. Patient is administered anesthesia to induce unconsciousness.
  2. Neurosurgeon makes an incision in the scalp and drills a small hole in the skull.
  3. Surgeon removes a portion of the skull to access the brain.
  4. Surgeon performs the necessary procedure on the brain, such as removing a blood clot or repairing damaged tissue.
  5. Surgeon closes the incision in the scalp and replaces the portion of the skull that was removed.

After Craniotomy:

  1. Patient is monitored closely in the intensive care unit for any complications.
  2. Patient may experience headaches, nausea, or confusion in the immediate postoperative period.
  3. Patient undergoes rehabilitation to regain strength and function.
  4. Patient follows up with the neurosurgeon for regular check-ups and imaging tests to monitor recovery.
  5. Patient may experience long-term effects such as cognitive deficits or seizures, depending on the extent of the injury and the success of the surgery.

What to Ask Your Doctor

  1. What is the purpose of a craniotomy and why is it being recommended for me?

  2. What are the potential risks and complications associated with a craniotomy procedure?

  3. How long will the recovery process be after a craniotomy and what can I expect during this time?

  4. Will I need any additional treatments or therapies following the craniotomy procedure?

  5. Are there any alternative treatment options to a craniotomy that I should consider?

  6. How experienced is the surgical team in performing craniotomy procedures?

  7. What is the success rate of craniotomy procedures for my specific condition?

  8. Will I need to follow any specific pre-operative instructions before undergoing a craniotomy?

  9. How long will the surgery take and what can I expect during the procedure?

  10. What is the long-term prognosis for someone who has undergone a craniotomy?

Reference

Authors: Raman V, Jiwrajka M, Pollard C, Grieve DA, Alexander H, Redmond M. Journal: ANZ J Surg. 2022 May;92(5):980-987. doi: 10.1111/ans.17457. Epub 2022 Jan 17. PMID: 35037369