Skip to main content

Care of the Postop Craniectomy/Craniotomy Patient

  • Chapter
  • First Online:
Surgical Critical Care Therapy

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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.

    Article  Google 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 

  5. Cooper DJ, Rosenfeld JV, Arabi YM, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–502. https://doi.org/10.1056/NEJMoa1102077.

    Article  CAS  PubMed  Google Scholar 

  6. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czonsnyka M, Timothy J, Kirkpatrick PJ. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375(12):1128. https://doi.org/10.1056/NEJMoa1605215.

    Article  Google Scholar 

  7. Quereshi AL, Ishfaq MF, Rahman HA, Thomas AP. Hemicraniectomy versus conservative treatment in large hemispheric ischemic stroke patients: a meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis. 2016;25(9):2209–14.

    Article  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.

  10. Lewis KS, Whipple JK, Michael KA, Quebbeman EJ. Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Pharm. 1994;51(12):1539–54.

    CAS  PubMed  Google Scholar 

  11. Fried HI, Nathan BR, Shaun Rowe A, et al. The insertion and Management of external ventricular drains: an evidence- based consensus statement - a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care. 2016;24(1):61–81.

    Article  PubMed  Google Scholar 

  12. Nyquist P, Bautista C, Jichici D, et al. Prophylaxis of venous thrombosis in Neurocritical care patients: an evidence-based guideline: a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care. 2016;24(1):47–60.

    Article  PubMed  Google Scholar 

  13. Cao Y, Pu K, Li Q, et al. The role of antibiotic prophylaxis in the clean neurosurgery. World Neurosurg. 2017;pii: S1878–8750(16)31423–1. doi:https://doi.org/10.1016/j.wneu.2016.12.108.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google 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 

  16. Arabi B, Chesler D, Maulucci C, Blacklock T, Alexander M. Dynamics of subdural hygroma following decompressive craniectomy: a comparative study. Neurosurg Focus. 2009;26(6):E8. Retrieved from http://thejns.org/doi/10.3171/2009.3.FOCUS0947.

    Article  Google Scholar 

  17. Ding J, Guo Y, Tian H. The influence of decompressive craniectomy on the development of hydrocephalus: a review. Arq Neuropsiquiatr. 2014;72(9):715–20. Retrieved from https://doi.org/10.1590/0004-282X20140106.

    Article  PubMed  Google Scholar 

  18. Greenberg MS. Posttraumatic hydrocephalus. In: Handbook of neurosurgery. New York: Theime Publishers; 2010. p. 906.

    Google Scholar 

  19. McClelland S, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007;45(1):55–9. https://doi.org/10.1086/518580.

    Article  PubMed  Google Scholar 

  20. Ashayeri K, Jackson E, Huang J, Brem H, Gordon CH. Syndrome of the trephined: a systematic review. Neurosurgery. 2016;79(4):525–34. https://doi.org/10.1227/NEU.0000000000001366.

    Article  PubMed  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

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mark Cipolle .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Moshkovsky, F., Mercante, M., Cipolle, M. (2018). Care of the Postop Craniectomy/Craniotomy Patient. In: Salim, A., Brown, C., Inaba, K., Martin, M. (eds) Surgical Critical Care Therapy . Springer, Cham. https://doi.org/10.1007/978-3-319-71712-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71712-8_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71711-1

  • Online ISBN: 978-3-319-71712-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics