Madison Starr

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A craniotomy is a neurosurgical procedure that can be performed electively or in an emergency setting. The surgeon removes a bone flap from the calvarium to access intracranial contents. It can relieve the patient of intracranial pressure, take out an intracranial hemorrhage, or drain an intracranial abscess. This procedure is life-saving but it does come with some life-threatening complications.
When a patient has a craniotomy, postoperatively the nurse must assess neurologic and vital signs every 15 to 30 minutes for the first 4 to 6 hours after the procedure, and then every hour after that. The nurse should report immediately and document any new neurologic deficits, particularly a decreased level of consciousness, motor weakness or paralysis, aphasia, decreased sensory perception, and sluggish pupil reaction to light (Ignatavicius, 2021). As well, the nurse should monitor the patient’s dressing for excessive amounts of drainage. Report saturated head dressing or drainage greater than 50 mL/ 8 hr immediately to the surgeon (Ignatavicius, 2021).
Tension pneumocephalus occurs when air collects in the subdural space via a one-way entry mechanism and leads to progressive mass effect onto the underlying brain parenchyma (Chughtai, 2019). Think of it as like a tension pneumothorax, this post-op complication is found on an MRI and it looks like the frontal lobes are peaking, which is called “Mount Fuji Sign” (Chughtai, 2019).
Another post op complication is infection. This can manifest as a formation of subdural empyema, intra abscess, and meningitis. The first signs of infection are typically seen at the skin and superficial fascia at the site of the initial incision. CT and MRI imaging will demonstrate skin thickening and superficial edema; correlation with physical exam is vital in identifying developing cellulitis and if left untreated, can lead to an abscess (Chughtai, 2019).
Extradural abscesses and subdural empyema incidence rate is 0.43% (Chughtai, 2019) but they can be potentially life threatening. They start off as superficial wound infections, and if left untreated, can develop into abscesses and empyema. In craniotomy patients the presence of sinusitis and otitis media can put the patient at greater risk for empyema.
Some amount of hemorrhage is to be expected with any surgical procedure but when large enough, these can be clinically significant and an emergent matter. Postsurgical intracranial hemorrhage can take the form of subdural or extradural hematomas, intraparenchymal hemorrhage, and cerebellar hemorrhage. Risk factors for developing a postoperative hemorrhage include: metabolic syndromes such as hypertension, diabetes, and coronary artery disease, anticoagulation, and extensive surgical excision.
It’s extremely important to know and recognize the signs and symptoms of different postoperative complications. Prompt recognition of something going wrong can be helpful maximizing the quality of care and life of the patient.

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