لینک پرداخت و دانلود *پایین مطلب*
فرمت فایل:Word (قابل ویرایش و آماده پرینت)
تعداد صفحه33
Craniotomy
The purpose of this document is to help prepare for upcoming brain surgery. It includes information about what to expect before, during, and after your operation. Please read it carefully. If you still have questions or concerns regarding your procedure after reading this guide, please discuss them with your CINN Outpatient Center Nurse or your CINN physician.
Understanding Your Surgical Procedure
The surgical procedure you will undergo is called a craniotomy. A craniotomy is a temporary opening of part of the cranium, or skull. A neurosurgeon performs a craniotomy to gain access to the disease or injury affecting the brain or its blood vessels.
A craniotomy is performed to:
- remove a lesion such as a tumor, nodule, cyst or neoplasm;
- remove a blood clot known as a hematoma;
- repair a leaking blood vessel known as an aneurysm;
- remove an abnormal collection of blood vessels known as an arteriovenous malformation or AVM;
- drain an infection or abscess;
- reroute circulation around a blocked blood vessel through techniques known as Microvascular Anastomosis or Extracranial-Intracranial (EC-IC) by pass;
- repair fractures of the skull that resulted from injury;
- remove pressure from a trigeminal nerve which is called a microvascular decompression; or
- remove pressure from the brainstem (Chiari decompression).
Your CINN physician has recommended a craniotomy because he or she believes this procedure is the best method for treating your condition.
Your Preadmission Testing Appointment
The CINN staff will arrange preadmission testing for you. Preadmission testing will last one to four hours depending on your diagnosis. During the appointment, you may undergo several tests and evaluations.
You may be evaluated by physical, occupational, and speech therapists. These therapists will assess your flexibility, muscle strength, and sensation. They will also assess your speaking and thinking skills and determine how your illness or injury may have affected your ability to work, care for yourself, and participate in the activities you enjoy.
A clinical psychologist may perform a behavioral medicine evaluation, which will help identify issues that may have an impact on your recovery. This evaluation will enable your CINN care providers to help you through the stress of surgery and any difficulties that may arise in the future. You may undergo blood tests, an electrocardiogram, a chest x-ray and perhaps Computed Tomography (CT), Magnetic Resonance Imaging (MRI) or other tests. A physician or nurse practitioner or physician assistant will conduct a comprehensive medical evaluation to assess the non-neurological aspects of your health. This caregiver will take a detailed medical history and conduct a thorough physical exam.
You may request a tour of the the intensive care unit where you will be after your surgery. A tour will allow you the opportunity to meet the nursing staff, and be given an explanation of the intensive care medical equipment.
The Week Before Surgery
You should stop from taking any over-the-counter medications containing Aspirin (Anacin, Bufferin, Ascriptin, etc.), Ibuprofen (Advil, Motrin, Nuprin, Aleve, etc.) or any other blood-thinning medications for one week prior to your surgery. Other medications you should not take 7-10 days prior to surgery are: Fiorinal, Darvon Compound 65 or Percodan. If you are on Coumadin, this will also need to be stopped about 5 days prior to surgery and a Prothrombin time checked on the morning of your surgery. Your medical doctor will advise you about the exact date of stopping the Coumadin in conjunction with your neurosurgeon. You may take Tylenol for pain if needed.
The Day Before Surgery
An anesthesiologist will evaluate your prior to your surgery. This evaluation will include asking you questions about your general health, allergies, previous surgeries, and past reactions to different anesthetics and may be done over the phone or at the hospital depending upon your specific needs.
You will be asked not to eat or drink any food or water after midnight the evening before your admission. You may brush your teeth and rinse your mouth, but do not swallow the fluid. Ask your Outpatient Clinic Nurse or your doctor about taking your usual medications the morning of your surgery.
The Day Of Surgery
If you have films from another hospital or facility, please remember to bring them with you the day of surgery. The hospital will call you several days prior to your admission to tell you what time you should arrive. When you arrive at the hospital, you will register at the Patient Registration/Admission Office. You will be asked to sign a surgical consent form that specifies the operation that you will undergo and that has been described to you by your doctor. You will then be directed to the General Care Unit or pre-operative holding area.
Your family and friends may remain with you until you leave your room for surgery. Depending on the reason for surgery, the length of the operation is from four to six hours or possibly longer. Ask your CINN physician the approximate length of your surgery.
If your surgery is scheduled for the morning, you will leave your room for surgery at approximately 7:00 a.m. If your surgery is scheduled for later, your nurse will inform you of the time it will take place. Your physician will try to prevent delays, but they can occur because of emergencies. If your surgery is delayed, your nurse will tell you when you can expect it to begin.
Preparing for Surgery
Before leaving your room, you will be asked to disrobe, put on a hospital gown, and empty your bladder. For your safety, you will be asked to remove hairpins, nail polish, make-up, jewelry, dentures, partial plates, hearing aids, contact lenses and glasses. Please store dentures, glasses, contact lenses, and hearing aids in containers labeled with your name. You should send your jewelry, wallet, and other valuables home with your family for safekeeping.
Accommodations for your Family
A surgical waiting area is available for your family to use while you are in surgery. During surgery, the operating room nurse will call the waiting area and provide your family with updates about your progress.
Entering the Operating Room
A transporter will assist you onto a cart and take you to the hospital's specially equipped neurosurgical area. When you arrive, the operating room nurse, anesthesiologist, and neurophysiology technician will talk with you and answer any questions you may have about the procedure.
Surgical Preparation
An intravenous (IV) catheter will be placed in your hand or arm at this time. The catheter allows for fluids and medications to be given to you during surgery. You will be given medication via the catheter and you will fall asleep. After you are asleep, the anesthesiologist will place a breathing tube in your throat to help you breathe during surgery.
After you are asleep, it may be necessary for the anesthesiologist to insert another catheter into an artery in your wrist in order to measure your blood pressure more accurately. It may also be necessary for the anesthesiologist to insert an IV catheter into your neck or upper chest area so that your blood pressure, fluid volume status or both can be measured accurately. Your heart rate and rhythm, breathing, blood pressure, and oxygen saturation will all be monitored closely by the anesthesiologist. Another catheter called a Foley catheter, will be gently placed into your bladder in order to accurately measure your urinary output. These catheters are all temporary and will be taken out within a few days of surgery. In order to maintain adequate blood circulation in your legs during surgery, tight white stockings called "TED Hose" and compressive boots will be placed on your legs. You will wear these during the entire surgery and during your recovery period.
Undergoing Surgery
Your body will be positioned according to the area of the brain that must be reached. A portion of your head may be shaved and washed with an antiseptic cleansing solution.
Your physician will make an incision in your scalp over the predetermined location. He or she will then make a window or bone flap in the cranium. It is through this bone flap that your physician will enter the brain and perform your surgery.
Your physician may use specialized instruments to perform the surgery. These instruments may include the Stealth Guidance System, surgical microscope, special magnification glasses, a surgical laser, and an ultrasonic tissue aspirator. If you are undergoing surgery for a tumor, a portion of the tumor that is removed will be given to a pathologist, who will analyze the tissue immediately. Based on the initial analysis of this tissue and other findings, your physician will choose to biopsy or remove the tumor. The pathologist will continue to analyze the tumor tissue and provide a detailed report about it approximately two to three days after surgery.
When your physician has completed surgery, the brain covering membrane (dura) is stitched closed, and the bone is replaced and sutured into place. The operation is completed when the skin has been closed with either stitches or staples. The breathing tube, used to help you breathe during surgery, will be removed. Your throat may be dry and a little scratchy. Your physician may decide, based on your physical condition, to keep the breathing tube in place overnight.
Beginning your In-Hospital Recovery
After your operation is complet
تحقیق در مورد کرانیوتومی (ENG)