Intracranial Surgery

Terms to Know
• Craniotomy
• Tentorium cerebelli
• Supratentorial
• Infratentorial
• Transphenoidal
• Craniectomy
• Cranioplasty
• Burr holes
 Preoperative Medical
Management
• Diagnostics • Medications
– CT – Antiseizure
– MRI • phenytoin (Dilantin)
– Cerebral angiography – Corticosteroids
– • dexamethasone
Transcranial doppler (Decadron)
studies
– Diuretics
• Osmotic: Mannitol
• Loop: furosemide (Lasix)
– Antibiotics
– Anxiolytics
• diazepam (Valium)
Preoperative Nursing Management
• Baseline assessment
• Assessment of patient and family
understanding and reactions
• Assessment of support systems
• Preparation for postoperative status
 Postoperative Medical Management
• Art line and CVP line
• Possible intubation
• Supplemental oxygen

• Goal of postoperative management:

– Detecting and reducing cerebral edema
– Relieving pain and preventing seizures
– Monitoring ICP and neurologic status
 Postoperative Nursing Management
• Maintaining cerebral tissue perfusion
• Regulating temperature
• Improving gas exchange
• Managing sensory deprivation
• Enhancing self-image
• Monitoring and managing potential
complications
 Potential Complications
• Increased intracranial pressure and bleeding
• Fluid and electrolyte disturbances
• Infection
• Seizure activity
• Later complications:
– VTE (venous thrombolytic events)
– Pulmonary and urinary tract infections
– Pressure ulcers
 Transphenoidal Approach to
Intracranial Surgery
• Indicated for:
– Sella turcica tumors
– Pituitary adenomas
– Ablation of pituitary
• Otorhinolaryngolgist on team
• Minimal risk of trauma and hemorrhage
• Avoids many risks of craniotomy
 Complications
• Transient Diabetes Insipidus
• Leakage of CSF
• Visual disturbances
• Postoperative meningitis
• Pneumocephalus
• SIADH
 Preoperative Managment
• Medical • Nursing
– Endocrine tests – Teach deep breathing
– Rhinologic evaluation – Instruct to
– Neruoradiologic studies postoperatively avoid
• Vigorous coughing
– Funduscopic exam and
• Blowing the nose
visual field
determinations • Sucking through a straw
• Sneezing
– Nasopharyngeal culture
– Possible corticosteroids
– Possible antibiotic
prophylaxis
 Postoperative Medical Management
• Medical
– Prevent infection
– Promote healing
– Medications
• Antimicrobials
• Corticosteroids
• Analgesics
• Vasopressing
 Postoperative Nursing Management
• Nursing
– Monitor VS
– Assess visual fields and acuity at intervals
– HOB elevated
– Avoid: blowing nose, bending or straining
– I&O, urine sp. gravity
– Daily wt
– Frequent check of nasal packing
– Oral care Q 4 hr
– Measures to promote mouth comfort