There are numerous types of brain surgery. The type used is based on the area of the brain and the condition being treated. Brain surgery is a critical and complicated process. The type of brain surgery done depends highly on the condition being treated. Intracranial surgery refers to various medical procedures that involve repairing structural problems in the brain. Craniotomy A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated. During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue Decompressive craniectomy  It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.

1. Chirayu College Of Nursing, Bhopal
Subject- Medical Surgical Nursing-I
Topic- Intracranial Surgery
Prepared By
Mr. Migron Rubin
Lecturer

2. INTRODUCTION
 There are numerous types of brain surgery. The type used is based on the area of the brain
and the condition being treated.
 Brain surgery is a critical and complicated process. The type of brain surgery done depends
highly on the condition being treated.

3. DEFINITION
 Intracranial surgery refers to various medical procedures that involve repairing
structural problems in the brain.

4. TYPES
 Craniotomy
 A craniotomy involves making an incision in the scalp and creating a hole known as a bone
flap in the skull. The hole and incision are made near the area of the brain being treated.
 During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or
fluid from an infection & remove abnormal brain tissue
 Decompressive craniectomy
 It is a neurosurgical procedure in which part of the skull is removed to allow a swelling
brain room to expand without being squeezed. It is performed on victims of traumatic brain
injury, stroke and other conditions associated with raised intracranial pressure.

5. ETIOLOGY
 Abnormal blood vessels
 Aneurysm
 Bleeding
 Blood clots
 Damage to the protective
tissue called the “dura”
 Epilepsy
 Abscesses
 Nerve damage or nerve
irritation
 Parkinson’s disease
 Pressure after head injury
 Skull fracture
 Stroke
 Brain tumors
 Fluid building up in the brain

6. MANAGEMENT
 PREOPERATIVE MANAGEMENT
1.Diagnostic findings, surgical procedure, and expectations are reviewed with the patient.
2. Presurgical shampoo with an antimicrobial agent may be ordered. Skull preparation is
performed in the operating room.
3. Depending on primary diagnosis, corticosteroids may be ordered preoperatively to reduce
cerebral edema.
4. Depending on the type and location of lesion, anticonvulsants may be ordered to reduce risk of
seizures.
5. The patient is prepared for the use of intraoperative antibiotics to reduce risk of infection.

7. Urinary catheterization is performed to assess urinary volume during preoperative period.
If cerebral edema develops, intraoperative or postoperative osmotic diuretic -mannitol or
corticosteroids may be ordered for its treatment.
Neurologic assessment is performed to evaluate and record the patient’s neurologic baseline
and vital signs for postoperative comparison.
Family and patient are made aware of the immediate postoperative care and where the
physician will contact the family after surgery.
Supportive care is given, as needed, for neurologic deficits.

8.  Postoperative Management
• Respiratory status is assessed by monitoring rate, depth, and pattern of respirations. A
patent airway is maintained.
• Vital signs and neurologic status are monitored using GCS
• Arterial and central venous pressure (CVP) are monitored.
• Pharmacologic agents may be prescribed to control increased ICP. Mannitol is given
• Incisional and headache pain may be controlled with mild analgesic (codeine and
acetaminophen)
• Position head of bed at 15 to 30 degrees, or per clinical status of the patient, to promote
venous drainage.

9.  Turn side-to-side every 2 hours; positioning restrictions will be ordered by the physician
(craniectomy patients should not he turned on the side of the cranial defect).
 Oral fluids are provided after swallow reflex and bowel sounds have returned. Intake and
Output are monitored.
 Speech therapy may be ordered for bedside swallow study or radiographic swallow
study.
 Signs of infection are monitored by checking craniotomy site, ventricular drainage, nuchal
rigidity, or presence of CSF (fluid collection at surgical site).

10. NURSING DIAGNOSES
 lneffective cerebral tissue perfusion related to increased ICF
 Risk for Aspiration related to decreased swallow reflex and postoperative positioning
 Risk for Infection related to invasive procedure
 Acute Pain related to surgical wound
 Constipation related to use of opioids and immobility

11. NURSING INTERVENTIONS
 Maintaining ICP Within Normal Range
1. Closely monitor LOC, vital signs, pupillary response and ICP, if indicated. Notify health
care provider if ICP is greater than 20 mm Hg or CPP is less than 60 mm Hg for more than
15 min.
2. Teach the patient to avoid activities that can raise ICP, such as excessive flexion or rotation
of the head and Valsalva maneuver (coughing, straining with defecation).
3. Administer medications as prescribed, to reduce ICP.
4. Eliminate noxious tactile stimuli, such as suctioning, prolonged physical assessment,
turning, and ROM exercises (based on patient response).

12. Preventing Aspiration
1. Offer fluids only when the patient is alert and swallow reflexes have returned.
2. Have suction equipment available at bedside. Suction only if indicated.
3. Pretreat with sedation or endotracheal lidocaine to prevent elevation of ICP.
4. Elevate head of bed to maximum of order, or per clinical status, and patient comfort.

13. Preventing Nosocomial Infections
1. Use sterile technique for dressing changes, catheter care, and ventricular drain
management.
2 Be aware of patients at higher risk of infection-those undergoing lengthy operations.
3Assess surgical site for redness, tenderness, and drainage.
4Watch for leakage of CSF, which increases the danger of meningitis.

14.  Relieving Pain
1. Elevate head of bed as per protocol to relieve headache. .
2. Pain management.
3. Darken room if patient is photophobic.
 Avoiding Constipation
1. Encourage fluids when patient is able to manage liquids.
2. Ambulate as soon as possible.
3. Change to non-opioid agents for pain control as soon as possible.
4. Avoid Valsalva’ like maneuvers.
5. Use stool softeners and laxatives, as ordered.

15.  Expected Outcomes
 Decreased ICP maintained greater than 70 mm Hg
 Gag reflex present; breath sounds clear
 Afebrile without signs of infection
 Verbalizes decreased pain
 Passed soft stool