Care of the Postop Craniectomy/Craniotomy Patient
Postoperative care of patients after having undergone craniotomy or craniectomy is common in the surgical ICU. It is vital for a modern surgical intensivist to have an understanding of indications for craniotomies and craniectomies, to have basic understanding of how the procedures are performed, and what to expect postop. This includes knowing indications for antibiotic use, drain care, seizure prophylaxis, and anticoagulation. Also, it is important to develop good neurological exam skills and have an understanding of the tiered approach to treating elevated intracranial pressures. Finally a basic understanding of common complications will undoubtedly aid in caring for these complex patients.
KeywordsCraniectomy Craniotomy Postoperative care Surgical critical care Neurosurgery
- 1.Hippocrates. (400 B.C.). On injuries of the head, Part 21. Translated by Francis Adams. Retrieved from http://classics.mit.edu/Hippocrates/headinjur.21.21.html
- 2.Bullock M, Chestnut R, Ghajar J, Gordon D, Hartl R, Newell D, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3):16–24. https://doi.org/10.1227/01.NEU.0000210364.29290.C9.CrossRefGoogle Scholar
- 3.Brain Trauma Foundation. (2016). Guidelines for the management of severe traumatic brain injury, 4th ed. Retrieved from https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf
- 4.Pascual JM, Prieto R. Surgical management of severe closed head injury in adults. In: Quiñones-Hinjosa A, editor. Schmidek & Sweet operative neurosurgical techniques. Philadelphia: Elsevier Saunders; 2012. p. 1527–30.Google Scholar
- 8.David Panczykowski, Benjamin Zusman, David Okonkwo, Joshua Bauer, Ava Puccio. Early discontinuation of subdural drain following evacuation of acute subdural hematoma does not increase risk of reoperation. Presented in Neurotrauma 2016. National Neurotrauma Society. June 26th, 2016. Accessed PubMed 14 Feb 2017.
- 9.ACS TQIP. https://www.facs.org/~/media/files/quality%20programs/trauma/tqip/traumatic %20brain%20injury%20guidelines.ashx. 2015. Accessed 13 Feb 2017.
- 14.Korinek AM, Baugnon T, Golmard JL, et al. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery. 2008;62(Suppl 2):532–9. https://doi.org/10.1227/01.neu.0000316256.44349.b1.CrossRefPubMedGoogle Scholar
- 15.Webb S, Timmons SD. Surgical management of traumatic brain injury. In: Winn B, Dacey, editors. Youman’s neurological surgery. Philadelphia: Elsevier Saunders; 2011. p. 3475–548.Google Scholar
- 18.Greenberg MS. Posttraumatic hydrocephalus. In: Handbook of neurosurgery. New York: Theime Publishers; 2010. p. 906.Google Scholar
- 21.O’Connor TE, Fargen KM, Mocco J. Normal perfusion pressure breakthrough following AVM resection: a case report and review of the literature. Open J Mod Neurosurg. 2013;3:66–71. Retrieved from http://file.scirp.org/pdf/OJMN_2013101516172598.pdf CrossRefGoogle Scholar