Our Summary

This research paper is about a medical procedure called Enhanced Recovery After Surgery (ERAS), specifically for craniotomy, which is a type of brain surgery. ERAS is a set of steps that doctors follow to help patients recover quickly from surgery, with the additional benefit of reducing health care costs. While ERAS has been used for various types of surgeries, it hasn’t been fully used in all areas of brain surgery.

The researchers found that ERAS for craniotomy can reduce the time patients spend in the hospital and lower costs without increasing the risk of complications. It could also help in reducing post-surgery nausea, vomiting, and the need for opioids, which are strong painkillers.

However, there are still some limitations and challenges in implementing ERAS for craniotomy globally. These challenges include lack of standard protocols, resistance from healthcare providers to change their usual practices, lack of resources, insufficient education, and lack of research.

The paper is a review of existing studies and information about ERAS for craniotomy from all around the world, contributed by experts from 26 different countries. They found that ERAS protocols need to be adapted to fit different healthcare systems and countries, especially those with lower and middle incomes.

Despite some limitations in the review process, this paper gives a comprehensive overview of the current use of ERAS for craniotomy globally and emphasizes the need for more adaptable ERAS protocols.

FAQs

  1. What is Enhanced Recovery After Surgery (ERAS) for craniotomy and how can it benefit patients?
  2. What are the challenges in implementing ERAS for craniotomy globally?
  3. Why does the ERAS protocol need to be adapted to fit different healthcare systems and countries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about craniotomy is to follow the post-operative care instructions carefully. This may include taking prescribed medications, attending follow-up appointments, and avoiding certain activities that could put strain on the surgical site. Proper care and attention to post-operative instructions can help ensure a smooth and successful recovery after a craniotomy.

Suitable For

In terms of patients who are typically recommended for craniotomy, the paper does not provide specific criteria. However, in general, patients who may benefit from craniotomy include those with brain tumors, aneurysms, arteriovenous malformations, traumatic brain injuries, and other conditions that require surgical intervention on the brain.

Patients who are considered for craniotomy are usually those who have exhausted non-surgical treatment options or for whom surgery is the best option for improving their condition. The decision to recommend craniotomy is made on a case-by-case basis by a multidisciplinary team of healthcare professionals, taking into account the patient’s overall health, the nature of their condition, and the potential risks and benefits of surgery.

It is important to note that not all patients with brain conditions are suitable candidates for craniotomy, as the procedure carries risks and may not be appropriate for every individual. Patients with certain medical conditions or who are deemed to be at high risk for complications may not be recommended for craniotomy.

Overall, the decision to recommend craniotomy is based on a thorough evaluation of the patient’s specific circumstances and involves careful consideration of the potential benefits and risks of the procedure.

Timeline

Before a craniotomy, a patient typically undergoes a series of tests and evaluations to determine the need for surgery and ensure they are healthy enough to undergo the procedure. This may include imaging studies such as MRI or CT scans, blood tests, and consultations with various specialists. The patient will also receive instructions on preoperative care, such as fasting before surgery.

During the craniotomy procedure, the patient is placed under general anesthesia, and a portion of the skull is removed to access the brain. The surgeon then performs the necessary procedure, such as tumor removal or clot evacuation. After the procedure is complete, the skull is usually replaced and secured with plates or screws, and the incision is closed.

After the craniotomy, the patient is typically monitored closely in the intensive care unit or a specialized neurosurgical unit. They may experience pain, nausea, and other side effects from the surgery, which are managed with medications. Physical therapy and rehabilitation may also be started early to help the patient regain strength and function.

In the postoperative period, the patient will gradually be transitioned to a regular diet, and they will be encouraged to start moving and walking to prevent complications such as blood clots. Depending on the complexity of the surgery and the patient’s overall health, they may be discharged from the hospital within a few days to a week after the procedure.

Overall, the goal of the ERAS protocol for craniotomy is to optimize the patient’s recovery and reduce the risk of complications, allowing them to return to their normal activities as soon as possible. By following the ERAS guidelines, healthcare providers can ensure a smoother and more efficient recovery process for patients undergoing craniotomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about undergoing a craniotomy using the ERAS protocol include:

  1. What specific steps will be included in my ERAS protocol for craniotomy?
  2. How will the ERAS protocol help me recover faster and reduce my hospital stay?
  3. Will the ERAS protocol affect my risk of complications during or after the surgery?
  4. How will the ERAS protocol help manage post-surgery symptoms such as nausea, vomiting, and pain?
  5. Are there any specific dietary or activity restrictions I need to follow before or after the surgery as part of the ERAS protocol?
  6. What resources or support will be available to me to help ensure the success of the ERAS protocol?
  7. How will the ERAS protocol be tailored to my individual needs and medical history?
  8. What research or evidence supports the use of ERAS for craniotomy, and are there any potential limitations to consider?
  9. Will my healthcare team be trained and educated on the implementation of the ERAS protocol for craniotomy?
  10. How will the ERAS protocol be adapted to fit the specific healthcare system and resources available in the hospital where I will undergo the surgery?

Reference

Authors: Di Donato A, Velásquez C, Larkin C, Baron Shahaf D, Bernal EH, Shafiq F, Kalipinde F, Mwiga FF, Jose GRB, Naidu Gangineni KK, Nijs K, Moipolai L, Venkatraghavan L, Lukoko L, Pandia MP, Jian M, Masohood NS, Juul N, Avitsian R, Manohara N, Srinivasaiah R, Takala R, Lamsal R, Al Khunein SA, Sudadi S, Cerny V, Chowdhury T. Journal: J Neurosurg Anesthesiol. 2025 Jul 1;37(3):255-264. doi: 10.1097/ANA.0000000000001011. Epub 2024 Nov 4. PMID: 39494915