Craniotomy in Türkiye

What is a craniotomy?

A craniotomy is a medical surgical procedure during which part of the skull bone (bony flap) is temporarily removed in order to reach the exact location within the brain to be treated with the help of computers and magnetic resonance imaging [MRI] or computed tomography [CT] which is a 3D image that informs In distinguishing between tumor tissue and healthy tissue.

Other procedures that require a craniotomy include a stereotaxic biopsy, where a needle is directed into the area to be examined in the laboratory and a sample is taken from that site, and also stereotaxic aspiration (removal of fluid from cysts and dural hematoma) and radiosurgery (as Systems 60 Cobalt), and an endoscopic craniotomy It is another type of craniotomy that involves inserting an endoscope, lighted with a camera, into the brain through a small incision in the skull, and clipping the blood in a cerebral aneurysm with clamps (intracranial aneurysm or brain aneurysm). The wall of one of the arteries in the brain leads to its swelling and enlargement abnormally, which means the risk of rupture (bursting) in the aneurysm, and it is treated, as mentioned above, by placing a metal clip to isolate the aneurysm by preventing the flow and thus preventing the danger.

Other related procedures that may be used to diagnose brain disorders include:

Diagram of cerebral arteries.
Brain computed tomography (CT).
Electroencephalogram (EEG).
Magnetic resonance imaging (MRI) of the brain.
Positron emission tomography (PET).
X-ray of the skull.

Types of craniotomy

Dilated frontal craniotomy:

A frontal craniotomy is used to target difficult tumors towards the frontal part of the brain. It is based on the concept that bone removal is safer than unnecessary penetration into the brain and a frontal craniotomy involves making an incision in the scalp behind the hairline and temporarily removing the frontal bone (this bone is replaced at the end of surgery) allowing work in the space between and immediately behind the eyes without the need for surgery. Unnecessary penetration of the brain.

Types of tumors treated by frontal craniotomy include meningiomas, sensory neuroblastoma, and malignant skull base tumors.

craniotomy supraorbital “eyebrow”

Supraorbital craniotomy is a procedure used to remove brain tumors by making a small incision inside the eyebrow to access tumors in the front of the brain or around the pituitary gland that are deep in the brain behind the nose and eyes. This approach is used instead of endoscopic intranasal surgery when the tumor is very large. Or close to the optic nerves or vital arteries.

This procedure is characterized by:

Less pain than with an open craniotomy.
Faster recovery than an open craniotomy.
Less scarring.

A posterior sigmoid craniotomy

It is a minimally invasive surgical procedure performed to remove brain tumors through a small incision behind the ear to allow access to the cerebellum and brainstem. Neurosurgeons use this approach to access certain tumors, such as meningiomas, neurofibromas (vestibular schwannomas), skull base tumors, and tumors. metastatic brain.

Orbitozygomatic craniotomy:

This approach is used in highly complex cases that cannot be treated by minimally invasive methods, and involves making an incision in the scalp behind the hairline and temporarily removing the bone that forms the circumference of the orbit and cheek (this bone is replaced at the end of the surgery) allowing access to the deep and difficult parts of the brain while reducing severe damage to the brain. Treatable brain tumors include craniopharyngeal tumors, pituitary tumors, and meningiomas.

Translabyrinthine craniotomy:

An incision is made in the scalp in the area behind the ear, then the mastoid bone and some of the bones of the inner ear (the bony semicircular canals) are removed, and then the surgeon removes all or part of the tumor without the risk of severe brain damage.

This approach is resorted to when it is possible to sacrifice the bony semicircular canals, and this is when hearing goes away or is not useful.

Reasons to perform a craniotomy:

It is done for several reasons, including, for example:

Diagnosis, removal or treatment of brain tumors.
Cut or treat an aneurysm.
Removing blood or blood clots from a leaking blood vessel.
Removal of an arteriovenous malformation (AVM) or treatment of an arteriovenous fistula (AVF).
Drainage of a brain abscess (pocket of suppuration)
Repair of skull fractures.
Repairing a tear in the membrane lining the brain (dura mater).
Reducing pressure within the brain by removing damaged or swollen areas that may have been caused by an injury or stroke.
Epilepsy treatment.
Implantation of stimulation devices to treat movement disorders such as Parkinson’s disease or dystonia (a type of movement disorder).

This is in addition to many other problems.

Procedure risks:

This procedure carries many risks and complications depending on the surgical site but in general they all share the following complications

infection occurs.
bleeding.
blood clots.
Pneumonia (inflammation of the lungs).
Unstable blood pressure.
seizures.
muscle weakness
brain tumor.
Cerebrospinal fluid (the fluid that surrounds the brain) leaks.
Risks associated with general anesthesia.

There are rare risks related to specific sites in the brain in addition to being not applicable to all patients, namely:

memory problems
Difficulty speaking
paralysis.
abnormal balance.
coma.

Before performing a craniotomy:

The patient’s complete medical history is taken and a complete physical examination is performed before the operation, in addition to blood tests and other diagnostic tests.
A preoperative neurological examination is used to compare with postoperative examinations
Fasting the night before the operation.
Inform the doctor if you are pregnant.
Tell the doctor about all the medications the patient is taking and herbal supplements, in addition to any allergies to medications.
Provide information about any medical history including bleeding disorders or if you are taking anticoagulant (blood thinning) medications, aspirin or other medications that affect blood clotting.
Stop smoking as soon as before the procedure.
Washing hair with a special antiseptic shampoo the night before surgery.
The patient receives a sedative before the procedure to help relax.
Shave the areas around the surgery site.

During the procedure:

A craniotomy requires a hospital stay of 3 to 7 days. Before the operation, the following steps are followed:

Remove any clothing, jewelry, or other items that may interfere with the procedure.
Wear a special surgical gown.
Inserting an intravenous (IV) line into the arm or hand.
Insertion of a urinary catheter to drain urine.
Placing the patient on the operating table in such a way as to provide the best access to the side of the brain to be operated on.
The anesthesiologist constantly monitors your heart rate, blood pressure, breathing, and blood oxygen level during surgery.
Shave the head and clean the skin over the surgical site with an antiseptic solution.
Fixation of the head with a device that will be removed at the end of surgery.
Pulling and cutting the scalp to control bleeding while giving access to the brain.
A medical drill can be used to make holes in the skull and a special saw can be used to carefully cut the bones.
The bony flap is removed and preserved.
The dura mater is separated from the bone and is carefully opened to expose the brain.
Allowing excess fluid to flow out of the brain
During the operation, microsurgical tools such as a surgical microscope are used to enlarge the area being treated, allowing a better view of the brain structures and distinguishing between abnormal and healthy tissues.
A pressure monitor is placed in the brain tissue to measure the pressure inside the brain
The surgeon sews the layers of tissue together once the surgery is complete
The bony flap is reattached using plates, sutures or wires but if a tumor or infection is found in the bone it probably cannot be replaced.
The surgical incision in the scalp is closed with sutures or surgical staples.
A sterile dressing is placed over the wound.

Post craniotomy stage:

in the hospital:

The recovery process varies according to the type of procedure performed and the type of anesthesia given but in general:

Immediately after the procedure, the patient is transferred to the recovery room for observation and then to the intensive care unit (ICU). In the intensive care unit, the patient may be given medication to reduce brain swelling. Once blood pressure, pulse, and breathing are stable, the patient is transferred to the neurosurgery unit in the hospital for several more days. The patient may need In this oxygen period the patient is taught to perform deep breathing exercises to help re-expand the lungs and prevent pneumonia.
Nursing and medical staff perform frequent neurological examinations to test brain function and ensure that body systems are functioning properly after surgery such as following a variety of basic commands (moving arms and legs, several questions) to assess brain function and encourage the patient to move, get up and walk as much as tolerated with their helper During that.
Compression devices (SCDs) are placed on the patient’s legs while he is in bed to prevent blood clot formation.
The patient is given fluids a few hours after surgery and the diet is gradually changed to include more solid foods.
It is possible that there will be a urinary catheter for about a day or more, and the doctor should be informed if there is pain when urinating, as these may be signs of an infection that can be treated.

At home:

It is important to keep the incision clean and dry and the patient is given special instructions for bathing.
The patient may wear a turban or a loose-fitting hat over the wound, however. The wig should not be worn until the wound has completely healed (about 3 to 4 weeks after surgery).
The wound and the head may hurt, especially with deep breathing, coughing, and effort, and at that time, a pain reliever can be taken under the supervision of a doctor.
The breathing exercises used in the hospital to prevent lung infection should be continued
It is advised to avoid exposure to upper respiratory illnesses (colds and flu) and irritants such as tobacco smoke, fumes, and environmental pollution.
Increase physical activity gradually and it may take several weeks to return to your previous level of energy and strength.
Avoid heavy lifting for several weeks.
Do not drive a car until the doctor authorizes it.

You should also contact your doctor in the following cases:

fever or chills;
Redness, swelling, bleeding, bleeding, or other drainage from the wound site or face.
Increased pain around the incision site.
vision changes
Confusion or excessive sleepiness.
Arm or leg weakness.
trouble speaking
Difficulty breathing, chest pain, anxiety, or a change in mental status.
Green, yellow, or blood-stained sputum (phlegm).

Neurosurgery and spine surgery in Türkiye:

Our multidisciplinary approach and treatment approach plays a major role in the success of brain surgeries. Neurosurgery and spine surgery is developing rapidly due to Türkiye’s keeping pace with the technology of innovations and modern medical devices. Thus, more successful results in diagnosis and treatment can be obtained.

Neurosurgeons and spine surgeons at REHABTÜRK HEALTHCARE PROVIDER NETWORK are leaders in the treatment of common and complex neurological disorders, adopting international best practices. We also offer advanced diagnostic, surgical and rehabilitation services.

Ask for a free consultation.