Disorders of the Central Nervous System (CNS)

Disorders of the Central Nervous System (CNS)

Postoperative Complications of a Craniotomy

Generally, craniotomy can be defined as the procedure that involves cutting through the skull and accessing the brain. The indications of craniotomy vary and include aneurysm repair, resection of brain tumors, and evacuation of hematoma. Just like any other surgery, craniotomy also has its complications. The common postoperative complications of craniotomy include infection, bleeding, brain edema, CSF leak, neurological deficits, and convulsions (Chughtai et al., 2019). Others may include deep venous thrombosis, chronic pain as a result of scar tissue, psychological disturbances, and hydrocephalus when the CSF circulation is interfered with.

The infections can either be on the surgical site or involve the brain. The surgical site infections may present as incision site discharge associated with pain and wound gaping. If left untreated, it may lead to brain abscess or meningitis. Moreover, bleeding may be excessive and warrant return to the operation room (Chughtai et al., 2019). Occasionally, there may be hematoma formation, leading to increased intracranial pressure. It is, therefore, crucial to assess for signs of increased intracranial pressure, including nausea and vomiting, persistent headache, reduced level of consciousness, convulsions, and neurological deficits (Buchowiz et al., 2021). The other cause of postoperative increased intracranial pressure is brain edema.

The neurological deficits that may be experienced include speech difficulties, sensory impairment, limb weakness, and impaired cognitive functions. Seizures are commonly observed, especially when a part of the brain is resected, which may have caused brain tissue irritation. This can, however, be managed with anticonvulsants. Consequently, deep venous thrombosis is a major concern due to immobility during recovery (Gupta et al., 2022). This justifies the indication of thromboprophylaxis post craniotomy. The dosages are calculated based on the patient’s risks. The patient’s risks for developing deep venous thrombosis should be assessed, and prophylaxis should be administered to prevent DVT and pulmonary embolism.

References

Buchowicz, B., Chen, B. S., Bidot, S., Bruce, B. B., Newman, N. J., Saindane, A. M., … & CSF-Leak Study Group. (2021). Prediction of postoperative risk of raised intracranial pressure after spontaneous skull base cerebrospinal fluid leak repair. Journal of Neuro-Ophthalmology, 41(4), e490-e497. https://doi.org/10.1097/WNO.0000000000001118

Chughtai, K. A., Nemer, O. P., Kessler, A. T., & Bhatt, A. A. (2019). Postoperative complications of craniotomy and craniectomy. Emergency Radiology, 26, 99-107. https://doi.org/10.1007/s10140-018-1647-2

Gupta, B., Uddin, M. B., Rei, K., Andraos, C., Reddy, V., Brazdzionis, J., … & Rei, K. M. (2022). Incidence and Risk Factors for Superficial and Deep Vein Thrombosis in Post-Craniotomy/Craniectomy Neurosurgical Patients. Cureus, 14(12). https://doi.org/10.7759/

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Module 02 Discussion – Disorders of the Central Nervous System (CNS)

Discussion Topic

You are preparing to work as a nurse in the neurology unit. The preceptor informs you to be prepared to discuss the following topics as they are commonly seen in the unit. In order to prepare, choose one of the following topics of interest as your initial discussion posting. Use this course’s resources and one evidenced-based article to explore the topic of your choice.

Disorders of the Central Nervous System (CNS)

How do you assess a client when the nurse suspects the onset of CVA?
Provide discharge information for a client with mild TBI.
Discuss surgical management of brain tumors.
Describe postoperative complications of a craniotomy.

When responding to the initial posting, provide an evidence based article to support your response. Respond to two other topics different than your initial topic.