Craniectomy is done in the operating room under general anesthesia. An incision is made in the scalp above the location of the hematoma, abscess, or other condition to be treated while the tissues are held open with small retractors. A bone flap is not turned. Instead, one or more small holes (burr holes) are drilled into the skull with a special drill. The edges of the burr holes are chipped away (rongeur) to enlarge the opening. If a larger opening is needed, a circular saw or a router blade craniotome may be used to connect the burr holes. The circular piece of bone is then removed, exposing a larger work surface for the surgeon.
The collection of blood, clots, or bloody fluid is suctioned out. To control vascular bleeding, the blood vessel is burned (cauterized) or clamped with clips. The brain is irrigated with saline irrigating solution until the return runs clear. A drain may be placed under the skull or dura mater and brought to the outside through a puncture hole in the scalp. The bone is not replaced, although under some circumstances, the long gap is filled with an acrylic material molded in the shape of the skull. The incision is closed and the wound is covered with a sterile dressing. |
Source: Medical Disability Advisor