Description
Diagram showing a craniotomy
Craniotomy is the removal of a portion of the skull in order to operate on the brain [1]. If the removed portion of bone is not put back in place, the procedure is called a craniotomy and the subsequent surgery to reconstruct the skull is called cranioplasty [2].
Indication
Craniotomy is used to treat and/or diagnose a variety of conditions, including[3][2]:
- Brain tumors.
- Brain haematoma.
- Aneurysms.
- Blood clots.
- Elevated intracranial pressure (ICP) is common after traumatic brain injury.
- Arteriovenous malformations (AVMs).
- Arteriovenous fistulas (AVFs).
- Brain abscesses.
- Dura mater tear.
- Skull fractures.
- Epilepsy.
- Implantation of stimulator devices for movement disorders.
Types of craniotomy
Craniotomy can be classified according to size of location or surgical technique [4]
The location classifications are[5]:
- Frontal
- Temporal
- Parietal
- Occipital
- Pterional (Frontotemporal)
- Suboccipital
- Retrosigmoid
- Orbitozygomatic
Sizes range from minimal burr or keyhole craniotomies to bone flaps several centimeters in diameter [4][6].
Another type of craniotomy is the awake craniotomy, in which the patient is awakened during the procedure [7].
Post-Op Physiotherapy
The level of physical therapy intervention and rehabilitation following craniotomy varies widely and is influenced by many factors, including the actual surgery, the circumstances of the treatment received, the patient’s premorbid condition, and the general impact of hospitalization [8].
In general, the goals of physical therapy after craniotomy are to maintain and/or increase range of motion and muscle strength, reduce and prevent spasticity and contractures, functional transfer or gait training, and improve balance and coordination [9].
In neuro-intensive care units, physical therapy interventions are both safe and beneficial [10]. Benefits include shorter hospital stay, less ventilation time, improved muscle strength, and increased independence in activities of daily living [11][12]. has been discovered Patients receiving ICP monitoring receive less frequent and less intense physical therapy [10], despite evidence that standard physical therapy practice is safe for these patients [13][14]. There is currently no fixed protocol for physical therapy after craniotomy [15], but nursing Guided by the results of the physical therapist’s assessment.
Patients may have long-term impairment in function and quality of life [16][17], for which they may require ongoing physical therapy intervention. Rehabilitation programs should be tailored to the individual patient’s capabilities, prognosis, and goals [18].
References
- ↑ Brain & Spine Foundation. Craniotomy Factsheet. Available from https://www.brainandspine.org.uk/our-publications/our-fact-sheets/craniotomy/ (Accessed 09/06/2022)
- ↑ Jump up to:2.0 2.1 Fernández-de Thomas RJ, De Jesus O. Craniotomy. Treasure Island (FL): StatPearls Publishing, 2022
- ↑ Johns Hopkins Medicine. Craniotomy. Available from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/craniotomy (Accessed 03/06/2022)
- ↑ Jump up to:4.0 4.1 Neurosurgeons of New Jersey. Understanding the Types and Purpose of Craniotomy. Available from: https://www.neurosurgeonsofnewjersey.com/blog/types-of-craniotomy/ (Accessed 09/06/2022).
- ↑ Rao, D., Le, R. T., Fiester, P., Patel, J., Rahmathulla, G. An Illustrative Review of Common Modern Craniotomies. Journal of clinical imaging science. 2020: 10; 81.
- ↑ Nahed B.V., Oglivy C.S., Anterior Circulation Aneurysms. In: Mohr J.P., Wolf P.A., Grotta J.C., Moskowitz M.A., Mayberg M.R., Kummer R.V. (editors). Stroke (Fifth Edition). W.B. Saunders, 2011. p.1301-1321.
- ↑ Medindia. Craniotomy. Available from: https://www.medindia.net/surgicalprocedures/craniotomy.htm (Accessed 03/06/2022).
- ↑ Taylor B.S., Kellner C.P., Connolly, Jr. E. Postcraniotomy Complication Management. In: Lee K.(editor) The NeuroICU Book (Seconds Edition) [Online]. 2017. Available from: https://neurology.mhmedical.com/content.aspx?bookid=2155§ionid=16396534 (Accessed 13/06/2022)
- ↑ Physio.co.uk. Neurosurgery. Available from: https://www.physio.co.uk/what-we-treat/neurological/neurosurgery/ (Accessed 14/06/2022)
- ↑ Jump up to:10.0 10.1 Sottile PD, Nordon-Craft A, Malone D, Luby DM, Schenkman M, Moss M. Physical Therapist Treatment of Patients in the Neurological Intensive Care Unit: Description of Practice. Phys Ther. 2015; 95:1 006-1014.
- ↑ Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil. 2013; 94: 551–561.
- ↑ Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S. Bittner E. et al. Early mobilization in critically ill patients: patients’ mobilization level depends on health care provider’s profession. PM&R. 2011; 3: 307–313.
- ↑ Brimioulle S, Moraine JJ, Norrenberg D, Kahn RJ. Effects of positioning and exercise on intracranial pressure in a neurosurgical intensive care unit. Phys Ther. 1997. Dec; 77: 1682-9
- ↑ Anneli Thelandersson. Early Physiotherapy in the Neurointensive Care Unit Passive Physiotherapy Interventions [Dissertation] Gothenburg: University of Gotherburg. 2016
- ↑ Srivastava A., Sharma N., Srivastav A K., Gehlot A. Functional rehabilitation in intensive care units for post craniotomy patients: study protocol. J. Physiother. Res. 2021: 11: 569-582
- ↑ Pfefferkorn T, Eppinger U, Linn J, Birnbaum T, Herzog J, Straube A. et al. Long-Term Outcome After Suboccipital Decompressive Craniectomy for Malignant Cerebellar Infarction. Stroke. 2009; 40: 3045-3050
- ↑ Mandona L, Bradaïa N, GuettardaI E, Bonana I, Vahedib K, Bousserb MG, et al. Do patients have any special medical or rehabilitation difficulties after a craniectomy for malignant cerebral infarction during their hospitalization in a physical medicine and rehabilitation department? Annals of Physical and Rehabilitation Medicine. 2010; 53: 86-95
- ↑ Parreiras de Menezes KK. Physical Therapy Rehabilitation after Traumatic Brain Injury. J Neurol Neurophysiol. 2016; 6: 311
