Intracranial Surgery

Terms to Know
Craniotomy Tentorium cerebelli Supratentorial Infratentorial Transphenoidal Craniectomy Cranioplasty Burr holes

Preoperative Medical Management

Diagnostics
CT MRI Cerebral angiography Transcranial doppler studies

Medications
Antiseizure
phenytoin (Dilantin)

Corticosteroids
dexamethasone (Decadron)

Diuretics
Osmotic: Mannitol Loop: furosemide (Lasix)

Antibiotics Anxiolytics
diazepam (Valium)

Preoperative Nursing Management

Baseline assessment Assessment of patient and family understanding and reactions Assessment of support systems Preparation for postoperative status

Postoperative Medical Management

Art line and CVP line Possible intubation Supplemental oxygen Goal of postoperative management:
Detecting and reducing cerebral edema Relieving pain and preventing seizures Monitoring ICP and neurologic status

Postoperative Nursing Management

Maintaining cerebral tissue perfusion Regulating temperature Improving gas exchange Managing sensory deprivation Enhancing self-image Monitoring and managing potential complications

Potential Complications
Increased intracranial pressure and bleeding Fluid and electrolyte disturbances Infection Seizure activity Later complications:
VTE (venous thrombolytic events) Pulmonary and urinary tract infections Pressure ulcers

Transphenoidal Approach to Intracranial Surgery

Indicated for:
Sella turcica tumors Pituitary adenomas Ablation of pituitary

Otorhinolaryngolgist on team Minimal risk of trauma and hemorrhage Avoids many risks of craniotomy

Complications
Transient Diabetes Insipidus Leakage of CSF Visual disturbances Postoperative meningitis Pneumocephalus SIADH

Preoperative Managment
Medical
Endocrine tests Rhinologic evaluation Neruoradiologic studies Funduscopic exam and visual field determinations Nasopharyngeal culture Possible corticosteroids Possible antibiotic prophylaxis

Nursing
Teach deep breathing Instruct to postoperatively avoid
Vigorous coughing Blowing the nose Sucking through a straw Sneezing

Postoperative Medical Management

Medical
Prevent infection Promote healing Medications
Antimicrobials Corticosteroids Analgesics Vasopressing

Postoperative Nursing Management

Nursing
Monitor VS Assess visual fields and acuity at intervals HOB elevated Avoid: blowing nose, bending or straining I&O, urine sp. gravity Daily wt Frequent check of nasal packing Oral care Q 4 hr Measures to promote mouth comfort