Trepanation is the act of opening cavities of bones in a limited area. For example, the trepanation of the mastoid process of the temporal bone, oral bone, tooth. The most widely used trepanation in neurosurgery - trepanation of the skull.
Craniotomy is used as the access for deletion intracranial hematomas, tumors of the meninges and the brain, with an open craniocerebral injury (see), depressed fractures of the skull and how palliative surgery in acute increase in intracranial pressure.
Interference on the brain, knowing the location of the pathological center, a surgeon with special sellotaping schemes by means of simple geometric constructions outlines place trephination so that the center trepanation holes match the location of a pathological focus.
There are resection and osteoplastic trepanning.
Resection craniotomy is to wykonywanie bone forceps holes of various sizes. Is applied at the emergency operations to remove intracranial hematomas, to reduce intracranial pressure, during the processing of a skull fracture. After resection trephination remains bone defect. If there are indications for postoperative bone defect closed different plastic materials.
Osteoplastic craniotomy involves cutting the skin-aponeurotic flap, then a bone graft, respectively location and size of a pathological focus that should be deleted. After the operation, bone graft is placed on the place and fix the seams for the periosteum.
Form of skin incision with osteoplastic trepanation is different and depends on selected for each case prompt access. Leg skin flap should be broad. It should be mainline vessels that supply nutrients to the tissues. The preservation of these vessels provides a good healing of wounds in the postoperation period.
After discharge of the skin-aponeurotic flap and detachment of periosteum with respetaron in both sides of the incision drilled in the bone 5-6 mazevyh holes across the section line periosteum. When all holes are drilled, bone between them saw through a 45-degree angle wire saw. For this purpose between neighbouring holes bone spend flat wire with wire saw. Cut the bones can also be performed by pneumatomachians. Bevel cutting at an angle of 45 degrees warns the punishments bone graft when it is laid in place at the end of the operation. Narrow leg bone at the base of the flap napylyayut wire saw almost to the periosteum and carefully naglasavajuci beneath the flap lifts. Bone flap remains associated with the skull only muscle and the periosteum. Dura reveal with education flap or cross.
After the operation sew hub with the silk sutures Dura. Bone flap stack on a place. Suture on the muscle and the periosteum. Then stack on a place of skin-aponeurotic flap and sewn up the skin.
After trephination to prevent postoperative bruising under the skin-aponeurotic, and sometimes bone scraps usually fail special graduates (strips of rubber glove or a rubber tube with side openings), which through seams in the dressing flows accumulated in the operating wound the blood. If not tightly sewn the meninges blood can flow mixed with cerebrospinal fluid. If the bandage get wet, then it is not revised, and podbitaya with absorbent cotton. Last impose a thick layer on the drenched region. Graduates, as a rule, the doctor removes a day after the operation. Meanwhile to prevent the expiration of cerebrospinal fluid and wound infections in the place, where stood graduates, pull together and tied makeshift seams or impose additional seams.
In the early postoperative period is very important, not whether there are bulging bandage over the area trephination, rapidly growing, swelling of soft tissues of the forehead and eyelids, bruising of the eye sockets, evoked postoperative intracranial haematoma.
Extremely dangerous complication after craniotomy is secondary likwore (see), as it may cause infection content of the skull with the development of meningitis and encephalitis. Therefore, if in the postoperative period bandage impregnated light liquid, you must pedunculate patient and to urgently inform the doctor about this complication.