Craniotomy: Difference between revisions

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== Post-Op Physiotherapy ==
== Post-Op Physiotherapy ==


The level of physiotherapy intervention and rehabilitation post craniotomy varies widely, and is influenced by a number of factors including the actual surgery, the condition which is being treated and also the general effects of being in hospital<ref>Taylor B.S., Kellner C.P., Connolly, Jr. E. Postcraniotomy Complication Management. In: Lee K.(editor) The NeuroICU Book (Seconds Edition) [Online]. 2017. Available from: <nowiki>https://neurology.mhmedical.com/content.aspx?bookid=2155&sectionid=16396534</nowiki> (Accessed 13/06/2022)</ref>.  
The level of physiotherapy intervention and rehabilitation post craniotomy varies widely, and is influenced by a number of factors including the actual surgery, the condition which is being treated, the patients pre-morbid condition and also the general effects of being in hospital<ref>Taylor B.S., Kellner C.P., Connolly, Jr. E. Postcraniotomy Complication Management. In: Lee K.(editor) The NeuroICU Book (Seconds Edition) [Online]. 2017. Available from: <nowiki>https://neurology.mhmedical.com/content.aspx?bookid=2155&sectionid=16396534</nowiki> (Accessed 13/06/2022)</ref>.  


Within Neurological Intensive Care Units, physiotherapy intervention is both safe and beneficial<ref name=":2">Sottile PD, Nordon-Craft A, Malone D, Luby DM, Schenkman M, Moss M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498141/ Physical Therapist Treatment of Patients in the Neurological Intensive Care Unit: Description of Practice]. Phys Ther. 2015; 95:1 006-1014. </ref>. The benefits include decreased length of hospital stay, decreased time on ventilation, improved muscle strength and increased independence in activities of daily living<ref>Li Z, Peng X, Zhu B, Zhang Y, Xi X. [https://pubmed.ncbi.nlm.nih.gov/23127305/ Active mobilization for mechanically ventilated patients: a systematic review]. Arch Phys Med Rehabil. 2013; 94: 551–561.</ref><ref>Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S. Bittner E. et al. [https://pubmed.ncbi.nlm.nih.gov/21497316/ Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession]. PM&R. 2011; 3: 307–313.  
Within Neurological Intensive Care Units, physiotherapy intervention is both safe and beneficial<ref name=":2">Sottile PD, Nordon-Craft A, Malone D, Luby DM, Schenkman M, Moss M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498141/ Physical Therapist Treatment of Patients in the Neurological Intensive Care Unit: Description of Practice]. Phys Ther. 2015; 95:1 006-1014. </ref>. The benefits include decreased length of hospital stay, decreased time on ventilation, improved muscle strength and increased independence in activities of daily living<ref>Li Z, Peng X, Zhu B, Zhang Y, Xi X. [https://pubmed.ncbi.nlm.nih.gov/23127305/ Active mobilization for mechanically ventilated patients: a systematic review]. Arch Phys Med Rehabil. 2013; 94: 551–561.</ref><ref>Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S. Bittner E. et al. [https://pubmed.ncbi.nlm.nih.gov/21497316/ Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession]. PM&R. 2011; 3: 307–313.  


</ref>. It has been found patients recieving intercrnaial pressure monitoring require less frequent and intensive physiotherapy<ref name=":2" />, <br>  
</ref>. It has been found patients undergoing intercranial pressure monitoring received less frequent and intensive physiotherapy<ref name=":2" />, despite the evidence standard physiotherapy practice is safe for these patients<ref>Brimioulle S, Moraine JJ, Norrenberg D, Kahn RJ. [https://pubmed.ncbi.nlm.nih.gov/9413447/ Effects of positioning and exercise on intracranial pressure in a neurosurgical intensive care unit.] Phys Ther. 1997. Dec; 77: 1682-9</ref><ref>Anneli Thelandersson. [https://gupea.ub.gu.se/bitstream/handle/2077/41549/gupea_2077_41549_3.pdf;jsessionid=A657A807EEDF4EB3C490AE8D22007785?sequence=3 Early Physiotherapy in the Neurointensive Care Unit Passive Physiotherapy Interventions] [Dissertation] Gothenburg: University of Gotherburg. 2016</ref>.
 
The short and long term goals of physiotherapy post craniotomy are to maintain and/ or increase range of motion and muscle strength, reduce and prevent spasticity and contractures, gait or transfer training, and to improve balance and coordination<ref>Physio.co.uk. Neurosurgery. Available from: https://www.physio.co.uk/what-we-treat/neurological/neurosurgery/ (Accessed 14/06/2022)</ref>.
 
<br>  


== Resources <br>  ==
== Resources <br>  ==

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Description[edit | edit source]

A craniotomy is an operation where a part of the skull is removed in order to perform surgery on the brain[1]. If the removed part of bone is not put back, the operation is instead called a craniectomy, and the following surgery where the skull is reconstructed is called a cranioplasty[2].

Indication[edit | edit source]

A craniotomy may be used in the treatment and/ or diagnosis of a number of conditions including[3][2]:

  • Brain tumours.
  • Brain haematoma.
  • Aneurysms.
  • Blood clots.
  • Increased intracranial pressure (ICP), common after traumatic brain injury.
  • Arteriovenous malformations (AVMs).
  • Arteriovenous fistulas (AVFs).
  • Brain abscesses.
  • Dura mater tear.
  • Skull fractures.
  • Epilepsy.
  • To implant stimulator devices for movement disorders.

Types of craniotomy[edit | edit source]

Craniotomies can be classified by the location, size or surgical technique[4]

The location classifications are[5]:

  • Frontal
  • Temporal
  • Parietal
  • Occipital
  • Pterional (Frontotemporal)
  • Suboccipital
  • Retrosigmoid
  • Orbitozygomatic


The size can range from the smallest, a Burr Hole craniotomy or a keyhole craniotomy, to operations with bone flaps that are multiple centimeters in diameter[4][6].

Another type of craniotomy is an awake craniotomy, where the patient is woken up during the procedure[7].

Post-Op Physiotherapy[edit | edit source]

The level of physiotherapy intervention and rehabilitation post craniotomy varies widely, and is influenced by a number of factors including the actual surgery, the condition which is being treated, the patients pre-morbid condition and also the general effects of being in hospital[8].

Within Neurological Intensive Care Units, physiotherapy intervention is both safe and beneficial[9]. The benefits include decreased length of hospital stay, decreased time on ventilation, improved muscle strength and increased independence in activities of daily living[10][11]. It has been found patients undergoing intercranial pressure monitoring received less frequent and intensive physiotherapy[9], despite the evidence standard physiotherapy practice is safe for these patients[12][13].

The short and long term goals of physiotherapy post craniotomy are to maintain and/ or increase range of motion and muscle strength, reduce and prevent spasticity and contractures, gait or transfer training, and to improve balance and coordination[14].


Resources
[edit | edit source]

add appropriate resources here

References[edit | edit source]

  1. ↑ Brain and Spine Foundation. Craniotomy Factsheet. Available from https://www.brainandspine.org.uk/our-publications/our-fact-sheets/craniotomy/ (Accessed 09/06/2022)
  2. ↑ 2.0 2.1 Fernández-de Thomas RJ, De Jesus O. Craniotomy. Treasure Island (FL): StatPearls Publishing, 2022
  3. ↑ Johns Hopkins Medicine. Craniotomy. Available from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/craniotomy (Accessed 03/06/2022)
  4. ↑ 4.0 4.1 Neurosurgeons of New Jersey. Understanding the Types and Purpose of Craniotomy. Available from: https://www.neurosurgeonsofnewjersey.com/blog/types-of-craniotomy/ (Accessed 09/06/2022).
  5. ↑ Rao, D., Le, R. T., Fiester, P., Patel, J., Rahmathulla, G. An Illustrative Review of Common Modern Craniotomies. Journal of clinical imaging science. 2020: 10; 81.
  6. ↑ Nahed B.V., Oglivy C.S., Anterior Circulation Aneurysms. In: Mohr J.P., Wolf P.A., Grotta J.C., Moskowitz M.A., Mayberg M.R., Kummer R.V. (editors). Stroke (Fifth Edition). W.B. Saunders, 2011. p.1301-1321.
  7. ↑ Medindia. Craniotomy. Available from: https://www.medindia.net/surgicalprocedures/craniotomy.htm (Accessed 03/06/2022).
  8. ↑ Taylor B.S., Kellner C.P., Connolly, Jr. E. Postcraniotomy Complication Management. In: Lee K.(editor) The NeuroICU Book (Seconds Edition) [Online]. 2017. Available from: https://neurology.mhmedical.com/content.aspx?bookid=2155&sectionid=16396534 (Accessed 13/06/2022)
  9. ↑ 9.0 9.1 Sottile PD, Nordon-Craft A, Malone D, Luby DM, Schenkman M, Moss M. Physical Therapist Treatment of Patients in the Neurological Intensive Care Unit: Description of Practice. Phys Ther. 2015; 95:1 006-1014.
  10. ↑ Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil. 2013; 94: 551–561.
  11. ↑ Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S. Bittner E. et al. Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession. PM&R. 2011; 3: 307–313.
  12. ↑ Brimioulle S, Moraine JJ, Norrenberg D, Kahn RJ. Effects of positioning and exercise on intracranial pressure in a neurosurgical intensive care unit. Phys Ther. 1997. Dec; 77: 1682-9
  13. ↑ Anneli Thelandersson. Early Physiotherapy in the Neurointensive Care Unit Passive Physiotherapy Interventions [Dissertation] Gothenburg: University of Gotherburg. 2016
  14. ↑ Physio.co.uk. Neurosurgery. Available from: https://www.physio.co.uk/what-we-treat/neurological/neurosurgery/ (Accessed 14/06/2022)
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