Our Summary

This research paper discusses a surgical procedure called craniotomy that is often used to remove tumors located in the suprasellar region of the brain in children. This region is located above the optic nerves and optic chiasm (the part of the brain where the optic nerves cross). Craniotomy is a preferred method for large tumors, tumors above the optic nerves and chiasm, tumors that extend sideways, and tumors with a lot of blood vessels.

There are different ways to perform a craniotomy, such as bilateral frontal and frontotemporal craniotomies. The choice of method depends on the size and location of the tumor, and its relationship to the optic nerves, optic chiasm, and blood vessels. The paper specifically focuses on two commonly used methods: the interhemispheric and pterional approaches.

In layman’s terms, the paper talks about a brain surgery method called craniotomy, mainly used for removing large or complex brain tumors in children. The choice of surgical approach depends on the tumor’s size, location, and its proximity to important structures in the brain. The paper provides detailed information on two commonly used approaches based on the authors’ experience.

FAQs

  1. What are some of the surgical procedures used for pediatric suprasellar tumors?
  2. Why is craniotomy often chosen for large tumors in the suprasellar region?
  3. What factors determine the selected approach for a craniotomy?

Doctor’s Tip

A doctor might tell a patient undergoing a craniotomy to follow their post-operative care instructions closely, including taking any prescribed medications, attending follow-up appointments, and avoiding strenuous activities. It is important to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for craniotomy include those with large tumors in the suprasellar region, tumors located above the optic chiasm and optic nerve, tumors extending laterally, and hypervascularized tumors. The surgical technique is often chosen by neurosurgeons who are familiar with it, and the approach for craniotomy is selected based on the direction of tumor extension and the relationship between the tumor and optic nerve, optic chiasm, and blood vessels. Commonly used approaches for craniotomy include bilateral frontal and frontotemporal craniotomies, interhemispheric and pterional approaches, orbitozygomatic approach, subtemporal approach using temporal-occipital craniotomy, and transpetrosal transtentorial approach using temporal-occipital-suboccipital craniotomy.

Timeline

Before craniotomy:

  1. Patient undergoes preoperative evaluations such as imaging studies (CT scans, MRI scans) and blood tests.
  2. Patient meets with the neurosurgeon to discuss the surgical procedure, potential risks and benefits, and postoperative care.
  3. Patient may need to stop taking certain medications prior to surgery and follow fasting instructions.

During craniotomy:

  1. Patient is brought to the operating room and given general anesthesia.
  2. Neurosurgeon makes an incision in the scalp and drills a small hole in the skull.
  3. A bone flap is removed to access the brain and tumor.
  4. The tumor is carefully removed using various surgical instruments and techniques.
  5. If needed, the neurosurgeon may use imaging guidance to ensure precise tumor removal.
  6. The bone flap is replaced and secured with plates or screws.
  7. The incision is closed with sutures or staples.

After craniotomy:

  1. Patient is monitored closely in the recovery room for any complications.
  2. Patient may experience pain, swelling, and discomfort at the surgical site.
  3. Patient may stay in the hospital for a few days for observation and recovery.
  4. Patient will be given instructions on wound care, medications, and follow-up appointments.
  5. Patient may need physical therapy or rehabilitation to regain strength and function.
  6. Patient will have regular follow-up appointments with the neurosurgeon to monitor recovery and discuss any further treatment options.

What to Ask Your Doctor

Some questions a patient should ask their doctor about craniotomy include:

  • What specific type of craniotomy will be performed for my condition?
  • What are the risks and potential complications associated with the craniotomy procedure?
  • How long will the recovery process be after the craniotomy?
  • What are the expected outcomes of the craniotomy surgery for my condition?
  • Will I need any additional treatments or therapies after the craniotomy?
  • How experienced is the surgical team in performing craniotomy procedures?
  • Are there any alternative treatment options to craniotomy that I should consider?
  • What can I do to prepare for the craniotomy surgery and optimize my recovery?
  • How long will I need to stay in the hospital after the craniotomy procedure?
  • What follow-up appointments or monitoring will be needed after the craniotomy surgery?

Reference

Authors: Ohe N. Journal: No Shinkei Geka. 2022 Nov;50(6):1332-1339. doi: 10.11477/mf.1436204699. PMID: 36426533