Stephen Josh V.

Lim BSN 3A

PROCEDURAL REPORT
Craniectomy

Definition

A craniectomy is a surgery done to remove a part of your skull in order to relieve pressure in that
area when your brain swells. A craniectomy is usually performed after a traumatic brain injury.
It’s also done to treat conditions that cause your brain to swell or bleed.

This surgery often serves as an emergency life-saving measure. When it’s done to relieve
swelling, it’s called a decompressive craniectomy (DC).

Purpose

A craniectomy decreases intracranial pressure (ICP), intracranial hypertension (ICHT), or heavy

bleeding (also called hemorrhaging) inside your skull. If left untreated, pressure or bleeding can
compress your brain and push it down onto the brain stem. This can be fatal or cause permanent
brain damage.

Instruments

 Bipolar Forceps
 Clamps and Forceps
 Curettes and Spatulas
 Dissectors and Rongeurs
 Drill bits, wire and pin instruments
 Elevators and Impactors
 Forceps
 Needles and Needle Holders
 Hooks and Probes
 Retractors, hand-held and self-retaining
 Scissors
 Spreaders
 Suction Tubes
Surgical Technique

A craniectomy is often done as an emergency procedure when the skull needs to be opened
quickly to prevent any complications from swelling, especially after a traumatic head injury or
stroke.

Before performing a craniectomy, your doctor will do a series of tests to determine if there’s
pressure or bleeding in your head. These tests will also tell your surgeon the right location for the
craniectomy.

To do a craniectomy, your surgeon:

1. Makes a small cut on your scalp where the piece of skull will be removed. The cut is
usually made near the area of your head with the most swelling.
2. Removes any skin or tissue above the area of the skull that will be taken out.
3. Makes small holes in your skull with a medical-grade drill. This step is called a
craniotomy.
4. Uses a small saw to cut between the holes until an entire piece of skull can then be
removed.
5. Stores the piece of skull in a freezer or in a small pouch on your body so that it can be put
back in your skull after you’ve recovered.
6. Performs any necessary procedures to treat the swelling or bleeding in your skull.
7. Stitches up the cut on your scalp once the swelling or bleeding is under control.

Nursing Responsibilities
Pre-operative
 Vital signs (heart rate, heart rhythm, blood pressure, temperature, respirations, and
oxygen)
 Preoperative blood work
 Electrocardiogram (EKG)
 Chest X-ray
 Lung function test
Intra Operative
 Ensure patient’s availability on the day of the surgery
  Prepare and monitor surgical equipment
 Assist the surgeon and anesthesiologist
 Help monitor vital signs and cardiac rhythm
 Monitor usage of supplies,
 Position the patient appropriately
 Keep the patient safe.
Post-operative
 Keep the head of the bed at thirty degrees to reduce intracranial pressure.
 Maintain normal body temperatures.
 Monitor swelling of the brain.
 Provide seizure precautions (tongue blade available for airway, pads on the bed rails, and
suctioning equipment set up).
 Complete frequent checks of overall skin integrity and surgical site status.
 Monitor intake and output of fluids, drainage, and secretions.
 Monitor respiratory status and encourage coughing and deep breathing; perform chest
percussion to loosen secretions if warranted.
 Perform regular orientation checks and reorientation as needed.
 Control pain of the patient.
 Do passive range of motion exercises to keep the patient's joints and muscles strong.

Surgical Position: Lateral Position