Craniotomy

Question 1

What two layers of the Scalp must be pierced by suture when closing?

Answer 1

• Skin

- Aponeurosis

Question 2

What is a Craniotomy?

Answer 2

Surgical removal of part of the Skull to expose the Brain

Question 3

What are some reasons to get a Craniotomy?

Answer 3

• Epidural/Subdural hematoma
• Tumor resection
• Aneurysm clipping

Question 4

What is a situation when a bone flap would not immediately be replaced?

Answer 4

If there is swelling of the Brain

Question 5

What are the two methods of storing a Bone Flap?

Answer 5

• Sterile packaging
  
  • In hospital or tissue processing center
• In patient’s abdomen

Question 6

What is Patient Positioning for a Craniotomy?

Answer 6

• Dependent on location of lesion/trauma
• Head must be stabilized
  
  • Mayfield Skull Clamp
  • Jelly Ring
  • Horseshoe Pillow

Question 7

What are the parts of the Mayfield Skull Clamp?

Answer 7

• Bed adaptor
• Base unit
• Swivel adaptor
• Skull clamp

Question 8

What are the items needed for the Mayfield Skull Clamp prep table?

Answer 8

• Mayfield Skull Clamp
• Mayfield Skull Pins
• Hair clippers
• Tape
• Comb
• Plastic bag for hair
• Marking pen

Question 9

What are the specific supplies needed for a Craniotomy?

Answer 9

• Rainey clips
  
  • Stops bleeding of the Scalp
• Cottonoids
  
  • Covers Brain while we work, keep soaked in saline

Question 10

What three instruments are needed for a Craniotomy?

Answer 10

• Midas Rex Drill (air powered)
• Perforator Drill Bit
• Tapered Drill Bit

Question 11

How is a Craniotomy opening performed?

Answer 11

Multiple burr holes are created around the border of the desired bone flap and then the holes are connected

Question 12

What must you take special care of while prepping a patient for a Craniotomy?

Answer 12

Not to get prep solution in the eyes or ear canals

Question 13

How is the patient draped for a Craniotomy?

Answer 13

• 4 towels placed around marked site
• Craniotomy drape placed over site
• 2 Suction tubes
• 1 Bovie
• 2 Bipolar Forceps

Question 14

What is the first step of a Craniotomy?

Answer 14

Incision and application of Rainey Clips

Question 15

What must the SA do while Rainey Clips are being applied?

Answer 15

Suction with one hand and digital pressure with the other to control Scalp bleeding

Question 16

True or False: You must never suction directly on Brain tissue.

Answer 16

True

-Use a Frazier suction tip on top of a Cottonoid

Question 17

What is the SA’s role during the Burr Hole process?

Answer 17

Constant irrigation to prevent the bone from burning

Question 18

What suture do we use to close the Dura?

Answer 18

4-0 Nurolon on a TF needle

Question 19

What can we use to close the Dura if there is Brain swelling?

Answer 19

Duragen (can be sutured or left to naturally adhere)

Question 20

How is a Bone Flap reattached?

Answer 20

Using plates and screws

Question 21

What suture do we use to close the Scalp Aponeurosis?

Answer 21

0 Vicryl on a CT1 Popoff needle

Question 22

What suture do we use to close the Scalp Dermis?

Answer 22

2-0 Vicryl on a CT1 Popoff needle

Question 23

What do we use to close the skin of the Scalp?

Answer 23

Staples

Question 24

What are the dressings used after a Craniotomy?

Answer 24

• Telfa
• 4x4s
• Kerlix head wrap