CRANIOTOMY
SURGERY
IN TURKEY
The surgical operations in which a bone flap is temporarily removed from the skull to access the brain in patients with a brain lesion due to a brain tumor, blood clots developed for various reasons, removal of certain foreign bodies or traumatic brain injury are called “craniotomy”.
WHAT IS CRANIOTOMY?
The situation in which the skull bone is removed in order to reach all the problems that require surgery in the head is called craniotomy.
Craniotomy is applied in any case where it is desired to reach every pathology in the brain. In a certain location of the skull, in the neighborhood of the problem, the skull is opened and the bone is removed.
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Craniotomy can be performed for the following reasons;
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Diagnosing, removing and treating brain tumors
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Circulating an aneurysm
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Removing blood or blood clots from a leaky blood vessel
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Removing an arteriovenous malformation (AVM) or treating an arteriovenous fistula (AVF)
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Draining an infected pus-filled brain abscess
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Repairing skull fractures
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Repairing tears in the membrane covering the brain (dura mater)
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Relieving pressure inside the brain (intracranial pressure) by removing damaged or swollen areas of the brain that could result from a traumatic injury or stroke
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Epilepsy treatment
HOW IS CRANIOTOMY SURGERY PERFORMED ?
Craniotomy can be performed with the patient asleep or awake, depending on the patient's condition.
How Is Awake Craniotomy Performed?
Only local anesthesia is applied in cases of small-sized brain tumors located in the superficial part of the brain (cortical). If a large scalp incision is to be made, a wide area of block is provided by injection of peripheral local anesthetic from the area near the base of the skin flap. In cases requiring wide craniotomy, they are put to sleep during craniotomy and awakened during mapping. The patient is put to sleep again during the tumor removal process (resection) and closure phase. It is preferable for the patient to be under sedation (anesthesia) for the comfort of the procedure until the opening of the cerebral cortex is completed. After the cerebral cortex has been opened, the cortical mapping phase begins.
Sensitive centers are determined by giving stimulation (stimulation) to the brain with special devices. The brain lodge, which is planned to be intervened in the surgery, is stimulated. After the mapping process is completed, the tumor is reached by making an incision in the area closest to the mass to be reached and in which it is determined that there is no functional cortex. If there is no functional response during the stimulation, neighboring gyri are stimulated. In motor field stimulation, symptoms such as muscle contraction, tremor, numbness and tingling in the sensory field are observed in the patient. In the speech center (Broka) stimulation, it is monitored whether there are signs such as pause in speech, pause in object naming, counting, and repetition of the spoken word. All interventions are performed using an operating microscope. When necessary and appropriate, care is taken to minimize brain tissue damage by using recesses (sulci) in the brain to approach the mass. During tumor removal, the patient's functions are constantly monitored. Especially during the removal of the glial tumor, since the normal tissue is intertwined with the tumor borders, the tumor lodge is stimulated and it is tried to stay within the safe area. If tumor involvement of functional areas is detected in MRI examinations, tumor resection is terminated in these areas, if necessary. Ultrasound of the surgical field during surgery and direct imaging of the tumor are also important to ensure that no tumor tissue is left behind.
FOR WHICH TUMORS CAN AWAKE CRANIOTOMY BE APPLIED?
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Glial brain tumors
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Brain metastases,
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Meningiomas,
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Cavernomas
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Arteriovenous malformations
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Other tumors
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Cortical dysplasia etc
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Stereotactic brain biopsy
ADVANTAGES OF AWAKE CRANIOTOMY
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Avoiding the risks of general anesthesia
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Reducing hospital stays
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Keeping the risk of neurological damage to a minimum while ensuring maximum removal of the tumor
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Brain edema is not observed in awake craniotomy.
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Minimizes the possibility of tumor residue.
Many patients are afraid of the idea of performing awake surgery, but when adequate explanation is given, it is seen that patients trust the doctor and adopt this method.
Some of the patients adapt easily with the thought that the risk of surgery decreases with awake surgical techniques, while some of them are worried that they will feel pain at that time. Patients should be relieved by explaining that they will be sedated with local anesthesia and that they will not feel pain during the surgery. Many patients tolerate awake surgery well. During the procedure, the anesthesiologist or another neurosurgeon monitors and examines the patient continuously.
FREQUENTLY ASKED QUESTIONS
Is craniotomy a risky surgery?
Craniotomy is a brain surgery that involves temporarily removing bone from the skull to repair the brain. Therefore, it brings some risks. Just under the skull, there are some vascular structures, venous sinuses carrying dirty blood, and brain tissue. In the craniotomy procedure, the cerebral cortex may rupture and damage the brain tissue, or the venous sinuses carrying this dirty blood may also rupture. These situations can cause problems that are reflected during or after some surgery.
However, risks are minimized when performed under appropriate conditions and by expert teams.
How long does craniotomy surgery take?
Craniotomy surgery varies according to the patient's condition and general picture. The skull bone is removed according to the area to be treated. However, this is only the duration of the craniotomy surgery. After the bone is removed, the surgery to be performed inside the brain is performed at varying times depending on the pathology and location of the problem.
How is Postoperative Monitoring Performed in Awake Craniotomy?
Within 24-72 hours after the surgery, the patients are checked for MRI, and the pre- and postoperative MRIs are compared and evaluated in terms of residual tumor (residual). The most common complication during the operation, especially during the brain mapping phase, is the patient's seizure. Seizures can be controlled with drug injections.