Bifrontal Craniotomy for Tumor
An extended bifrontal craniotomy is a surgical procedure used to remove difficult frontal lobe tumors from the brain. Tumors may not be appropriate for excision during more minimally invasive operations either because they are less accessible anatomically or that their pathology is more complex. Tumors treated by this surgery include meningiomas, esthesioneuroblastomas, and malignant skull base tumors. The perceived advantage of extended bifrontal craniotomy is that removing a piece of the skull bone temporarily by creating a bone flap is considered safer than moving, and possibly jarring, the brain itself.
This surgery may be performed under general or local anesthesia. During the craniotomy, the patient's head is immobilized and a strip of hair may be removed from the scalp. The neurosurgeon makes a coronal incision in the scalp over the top of the head, and temporarily removes the bone that forms the orbital contours and forehead. This removed bone flap is preserved for replacement at the conclusion of the procedure. By creating and removing this flap, and cutting through the membrane that surrounds the brain, known as the dura mater, the surgeon can access the space behind the eyes and remove the tumor without risking manipulation of the brain.
At the end of the operation, the dura mater is stitched or stapled closed, the skull flap is put back and anchored in place and, if necessary, a drain is inserted to provide a pathway for excess fluid to escape. Finally, the skin flap is reattached over the skull.
In most cases, recovery from an extended bifrontal craniotomy goes smoothly, but there are risks inherent in an surgical procedure, particularly those involving the brain. In additional to the usual risks, such as infection or blood clots, this surgery may, although rarely, result in leakage of cerebrospinal fluid, or disturbance of memory or other cognitive functions.
Burr Hole Drainage
Burr hole drainage is a surgical procedure used to remove a blood clot near the brain. These blood clots are known as subdural hematomas because they form under the dura, which is the protective covering of the brain. Hematomas usually require removal because they can compress the brain tissue and cause life-threatening complications. In certain cases, a traditional open surgery, known as a craniotomy, may be necessary. But many hematomas can successfully be removed using burr hole drainage, in which a small perforation is created through the skull to suction out the blood and relieve pressure on the brain.
The Burr Hole Drainage Procedure
A burr hole drainage procedure requires the use of general anesthesia. The patient's head is shaved at the treatment site. Once the head is correctly positioned by the surgical team, an antibiotic solution is applied to prevent infection. The surgeon will make a small incision in the scalp, then use a special surgical drill to create a small perforation in the skull. The dura is cut open to reveal the hematoma. Irrigation is employed to rinse the area out. The surgeon will next thoroughly drain the region via tubing to ensure that the blood clot and any excess fluid has been evacuated. Once that has been accomplished, the surgeon will close the incision.
Risks of Burr Hole Drainage
While a burr hole drainage procedure is relatively common and much less invasive than open forms of brain surgery, it does still pose a number of risks. The complications of burr hole drainage may include brain injury, accumulation of fluid around the brain, seizure, stroke, weakness, paralysis, bleeding and infection.
Recovery from a Burr Hole Drainage Procedure
Patients are generally required to remain in the hospital for a period of several days following a burr hole drainage procedure. A patient's activities may be restricted for the first few weeks after surgery, and they are advised to avoid any strenuous forms of exercise or activities that might result in a head injury.
Many of the symptoms typically experienced with a subdural hematoma, such as headaches, balance problems, numbness, weakness and speech issues, are often resolved immediately after the surgery. Some patients require rehabilitation services to restore their previous functionality. In certain cases, seizures may persist for some time after the burr hole drainage procedure, but can generally be managed by taking prescription anticonvulsant medication.
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