CRANIAL SURGERIES

OPERATIVE PROCEDURES
• Burr Holes
o Neurosurgical procedure make bone flap skull; aspirate or evaluate

• Craniotomy
o Opening skull surgically to gain access to intracranial structures

• Craniectomy
o Excision of portion of skull without replacemnt (control ICP)

• Cranioplasty
o Repair cranial defect by means of plastic or metal plate; restablishing, contour and
integrity

• Supratentorial
o Above tentorium

• Infratentorial
o Below tentorium, brain stem

PREOPERATIVE CARE
• Establish baseline assessment
• NPO check list and teaching
• Shave scalp or cut hair – Wash hair – wait for order from MD
• Restrict fluids ( ICP)
• Anticonvulsant meds – Due to blood irritation
• Steroids –  cerebral edema - Decadron
• Mannitol –  Fluid – Osmotic Duiretic
• Lasix –  Fluid in the interstitial spaces caused by use of Mannitol
• Diazepam
• Indwelling cath
• Central line (Monitor CVP, Fluid)

POSTOPERATIVE CARE
• Frequent neuro checks
• Nothing to increase ICP
• Monitor Respiratory status
• Assessment of: Arterial Line, CVP line
• O2 Therapy
• Dexamethasone
 • Monitor serum levels

COMPARISON OF
POSTOPERATIVE CARE
SUPRATENTORIAL INFRATENTORIAL

Made directly over the area to be Made slightly above the nape of the
INCISION explored on cerebral cortex. neck around the occipital region.

POSITION OF Flat with small pillows under neck

Eletaved 30 to 45o
Head of bed is gradually elevated as
HEAD OF Place large pillows under head and
ordered by DR May be  30o
BED shoulders
Neutral position No Flexion

Either side.
TURNING Either side or back
Some Dr’s do not allow patient on
THE PATIENT Do not turn to operative side back

Out ob bed when vertical position does

Out ob bed – depends on MD
AMBULATION not make patient dizzy. Pt experiences dizziness
Depends on MD

NPO at least 24 hours

NPO for 24 hours; IV fluids
NUTRITION Watch for fluid restriction orders
Nausea prevalent
Watch for fluid restriction.
Swallowing and gag reflexes must be
checked
Cranial IX, X edema

Foley catheter care BID

Watch for S/S of diabetes insipidus
ELIMINATION Administer daily stool softnerer to
Same as supratentorial
avoid Valsava’s maneuver
POSTOPERATIVE COMPLICATIONS
• Shock
o Hypovolemic or Hemorrhagic
 Due to bleeding of scalp
• Check dressing Check VS – P and BP
• Restlessness Cold and clammy Monitor Urinary output
• Increased Intracranial Pressure
o Peak at 72 hours post op
o Look for S/S of  ICP
• Cerebral Edema
o Decadron, Mannitol NO
o Give antacids for GI upset TRENDELENGURG
• Respiratory Complications
o Maintain airway
o Check gag reflex
o Prevent Pneumonia
o Turn and Deep Breathe **DO NOT COUGH**
• Convulsions
o Dilantin
o Blood irritant – Give prophylactic anticonvulsants
• Meningitis
o Drainage ear and nose
o Note temperature
• Wound Infection
o Aseptic technique – Sterile Technique
o Observe S/S of infection

• Diabetes Insipidus
o Excessive urinary output; Large amount of dilute urine with Specific Gravity
o Deficit ADH
o Thirst
o  specific gravity
o  serum Na levels
 Could correct self
 Have to give fluids and monitor hourly I&O
• Inappropriate secretion of ADH (SIADH)
o Syndrome of inappropriate ADH
o Decrease in urine output
o  specific gravity
o  serum Na levels – dilution in body – Hypernatremia
o Monitor I&O and Give Diuretics

• Loss of corneal reflex

o Injury
• Swelling around eyes
• Visual problems
•  LOC
 • Communication deficit

OVERALL NURSING MANAGEMENT Handwritten notes begin

• Frequent neuro, VS assessment; diagnostic assessment

• Monitor for thrombus formation
o TED, SCD hose
• Skin care
• Turn Q2o and position properly
• ROM
• Catheter care
• Inspect eyes
• Safety precautions
• Evaluate restlessness – Possible cause
• Provide self care activities
• Monitor I’s and O’s
• Monitor lab reports

TRANSSPHENOIDAL SURGERY
• Pituitary Surgery
• Microsurgery
o Insicion in upper submucosa gum area; sella floor removed; dura incised; tumor
removed; graft of muscle from anterior surface of thigh patched on surgical site;
nasal Vaseline patches inserted to restore nasal mucosa

NURSING CARE WITH TRANSSPHENOIDAL SURGERY

• Monitor neuro status
• Monitor VS
• Monitor Dsg (SF leakage, monitor pt for C/O postnasal drip, constant swallowing)
• Monitor I/O’s and specific gravity
• Note C/O extreme thirst
• Frequent mouth care (no toothbrushing): humidifiers
• No nose blowing or sneezing for one month after nasal packing remived
• Nasal speculum, long forceps redily available
• High Fowlers Position

Give Codiene because you do not want to alter LOC

Read careplan in Burnner p.1668 -1669