Cranial Surgeries

Three Meningeal Layers:

 Dura Mater
 Arachnoid Mater
 Pia Mater

Common Types of Cranial Surgeries:

A. Craniotomy

An operation in which a small hole is made in the skull or a piece of bone from the skull is removed to show part of the
brain. The piece of bone that is removed from the skull is usually put back in place after the surgery has been done.

Purpose:

 To remove Tumor,
 Relieve elevated ICP (Increased Intracranial Pressure)
 Evacuate a blood clot, and control Hemorrhage.
 Repair a tear repair a tear in the dura mater (membrane lining the brain)

Common Risks:

 Infection
 Bleeding
 Blood clot
 Muscle weakness
 Brain swelling

B. Craniectomy

It is a neurosurgical procedure that involves removing a portion of the skull.

Purpose:

Is to relieve extra pressure on the brain. Medical conditions that may lead to this increased pressure include:

 Severe head injury that causes swelling or bleeding in or around the brain
 Stroke (hemorrhagic or ischemic)
 Subarachnoid hemorrhage
 Blood clot in the brain’s venous sinus (large veins around the brain)
 Swelling from a brain tumor

C. Cranioplasty

Is the surgical repair of skull fractures or deformities using a biologic or synthetic material made of plastic or metal. These
fractures and deformities can happen as the result of a neurosurgical operation that required access to the brain, a
traumatic accident, or a birth defect.

D. Blur Holes

Circular openings for exploration or diagnosis, to provide access for ventricles, for shunting procedures, to aspirate a
hematoma or abscess, or to make a bone flap.

Bone Flap - section of bone temporarily removed.

Shunting - to help drain cerebrospinal fluid and redirect it to another location in the body where it can be reabsorbed
(peritoneal cavity, the atrium, or the pleura)

Pre – Operative Management

Medical Management

 Pre-operative diagnostic procedures may include CT scan, MRI, Angiography, or Transcranial Doppler flow
studies.

Transcranial Doppler Flow - test that uses sound waves to examine blood flow in your brain.

Angiography - is a type of X-ray used to check blood vessels. Blood vessels do not show clearly on a normal X-ray, so a
special dye called a contrast agent needs to be injected into your blood first.

 Medications are usually given to reduce risk of seizures (Levetiracetam / Keppra)

 Corticosteroids, fluid restriction, hyperosmotic agents (Mannitol), and diuretics maybe used to reduce cerebral
edema.
 Antibiotics maybe administered to reduce potential infection.
 Diazepam (Anxiolytic) maybe used to alleviate anxiety

Nursing Management

 Obtain baseline neurologic assessment (assessing mental status, cranial nerves, motor and sensory function,
pupillary response, reflexes, the cerebellum, and vital signs)

Sample assessments:

 Glassgow Coma Scale

 Cranial Nerve Testing/Examination

 Assess patient and family understanding of a preparation for surgery.

 Stop Smoking
 Allergies to Latex, tape and Medications

 Provide Information and support.

Post-Operative Management

 Post operative care is aimed at detecting and reducing cerebral edema, relieving pain, preventing seizures, and
monitoring ICP and neurologic status.
 This patient maybe intubated and have arterial and central venous lines.

Nursing Diagnosis for Cranial Surgery

 Ineffective Cerebral Tissue Perfusion

 Risk for Imbalanced Body Temperature
 Potential for impaired Gas Exchange
 Disturbed sensory perception
 Body Image disturbance
 Impaired Communication (aphasia)
 Risk for Impaired Skin Integrity
 Impaired Physical Mobility
Assessment of Intracranial Surgery

 Careful, frequent monitoring of respiratory function, Including ABG’s.

ABG – Arterial Blood Gas – Measure Oxygen, Carbon Dioxide, PH levels.

 Monitor VS and LOC frequently; note any potential signs of IICP.

 Headache.
 Blurred vision.
 Feeling less alert than usual.
 Vomiting.
 Changes in your behavior.
 Weakness or problems with moving or talking.
 Lack of energy or sleepiness.

 Assess dressing and for evidence of bleeding or CSF drainage.

 Monitor for Potential Seizures; if seizures occur, carefully record and report them.
 Monitor for signs and symptoms of complications.
 Monitor fluid status and laboratory data.

Planning the Care

 Major Goals may include:

 Improve Tissue Perfusion
 Adequate Thermoregulation
 Normal Ventilation and Gas Exchange
 Ability to Cope with sensory deprivation
 Adaptation to change in body image
 Absence of complication