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    Cool 9 Neurosurgery lectures

    20.4 Techniques for craniotomy
    20.4.1 PREOPERATIVE PREPARATION
    In general, cranial surgery should not be performed
    until a stable blood pressure and adequate lung
    function, confirmed by blood gas analysis, have been
    achieved (Chapter 17).
    However, in a patient who is comatose, particularly
    if there has been a documented deterioration in
    conscious level or development of focal signs, removal
    of the hematoma is a matter of great urgency. The
    patient should be intubated and hyperventilated, if
    this has not already been done, and mannitol 1 g/kg
    should be given immediately as the patient is taken to
    the operating theater.
    Prior to, or during the preparation for craniotomy,
    the following ‘checklist’ should be completed:
    1. blood to laboratory for:
    (a) cross matching (2 units of whole blood);
    (b) coagulation studies
    (i) prothrombin index
    (ii) partial thromboplastin time
    (iii) platelet count;
    (c) blood gas analysis;
    (d) routine full blood count and electrolytes;
    2. X-rays of chest and cervical spine (or keep cervical
    spine in collar);
    3. consent for surgery;
    4. Foley catheter in bladder;
    5. two large bore peripheral i.v. lines, or one peripheral
    and one central line (maintaining
    CVP> 5cmH2O);
    6. arterial catheter;
    7. protection of both eyes from fluids and pressure;
    8. adequately secured cuffed endotracheal tube.
    The head should be placed on a horseshoe or
    doughnut headrest, turned to place the operative side
    uppermost and slightly elevated above the level of the
    heart. A sandbag placed beneath the ipsilateral shoulder
    makes turning the head easier. Pressure points
    should be carefully padded. Unless deterioration is
    rapid, the scalp should be shaved and prepared withpovidone-iodine as for any other intracranial procedure.
    The drapes can be stapled into place to prevent
    them becoming dislodged if the head has to be turned
    or moved during the procedure. Antibiotics, anticonvulsants
    and mannitol are used as required. Strict
    attention to anesthetic techniques is vital to avoid
    hypercarbia and further elevation of intracranial
    pressure.
    20.4.2 EXPLORATORY BURRHOLES
    With the wider availability of CT, the necessity for
    exploratory burrholes is declining. They will be
    required only very rarely in hospitals with a CT
    scanner; however, they may be life-saving in rural
    locations where transfer to a CT-equipped facility may
    involve long delays.
    The use of exploratory burrholes implies that
    confirmation of the position or even the presence of a
    hematoma is lacking. It is therefore important to have
    access to the whole head and to explore all likely sites
    bilaterally before discarding the diagnosis of intracranial
    hematoma. The extent of this exploration will
    be determined at least in part by the experience and
    skills of the operator, given that this will frequently be
    a non-neurosurgeon working in less than ideal circumstances.
    It should always be possible to obtain
    neurosurgical advice by telephone and this should be
    encouraged. Specific guidelines for the management
    of head injury in remote locations in Australia have
    been established by the Neurosurgical Society of
    Australasia.
    (a) Technique
    The patient is placed supine on a horseshoe or
    doughnut headrest. The whole head is shaved, prepared
    and draped to allow access to both frontal,
    parietal and temporal areas. The site for the initial
    burrhole is determined according to the most likely

    site of the suspected hematoma. If a dilated pupil is
    present, it will usually be ipsilateral to the hematoma.
    The next most valuable localizing feature is a hemiparesis,
    which will usually be contralateral to a hematoma.
    If a fracture is present it is most likely to overlie
    an extradural hematoma. It must be stressed that none
    of these signs is absolute and if no hematoma is found
    on the suspected side, the other side should be
    explored in all cases.
    Unless a fracture is present in a different location,
    the first burrhole should be temporal, as this is the site
    of most extradural hematomas. It is frequently written
    that a burrhole placed as little as 2 mm away from the
    edge of an extradural hematoma will fail to identify it,
    and this tends to discourage the inexperienced doctor
    in a difficult situation.

    This is just an extract of these lectures.

    There r 8 other lectures included in the folder on the following topics:
    -Anterior communicating artery aneurysm
    -Arteriovenous malformations
    -Gliomas
    -Head injury
    -Spine injury
    -Peripheral nerve injury
    -Spinal tumors
    -Peripheral nerve tumors
    -Spinal nerve tumors


    [hide]http://ifile.it/v4fa0kr[/hide]

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    i very appreciatrd

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    thanks a lot

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    Default 9 Neurosurgery lectures

    Thanx alot bro

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    thanks a lot

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    No such file is available to download

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    thank you

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    Default Thannnnnnnks

    Thanxxxxxxxxxxxxxxxxxx

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    Thanxxxxxxxxxxxxxxxxxx

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