Craniotomy

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Craniotomy

A craniotomy is the neurosurgical opening of the bony skull ( Latin cranium ) by trepanation . This creates access through the skull bone into the interior of the skull in order to carry out further neurosurgical intervention on the brain (for example resection of a tumor) there. In this procedure, part of the skull bone is cut out. After the operation, the bone flap is reinserted, provided it has not been destroyed by tumor growth or trauma.

procedure

The first step is the incision of the scalp. On the exposed skull bones are with a trephine drill more holes generated along the planned line of resection. The next step is to join the existing holes. A surgical milling instrument, the so-called craniotome, is used. The end of the milling cutter is provided with an angled shoe, the so-called dura remover , with which the dura mater adhering to the bone is detached. This is to protect the meninges from injuries caused by the milling instrument.

history

As early as the Neolithic Age (8000-5000 BC), craniotomies were successfully carried out, as archaeological finds show. This makes the craniotomy the oldest proven surgical procedure. Likewise, the craniotomy was used in ancient and medieval cultures.

They are necessary, for example, after a fracture of the base of the skull or a traumatic brain injury . In desperate cases in which the child's skull could not pass the woman's bony pelvis at birth, this method, already described by Hippocrates , was used well into the 18th century. The aim of the intervention was to reduce the size of the child's skull. Before the introduction of the caesarean section, this was the only way to save the life of the mother (if not the child) in the cases described .

See also

literature

  • LB Morgenstern, AM Demchuk, DH Kim, RF Frankowski, JC Grotta: Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage . In: Neurology . tape 56 , no. 10 , May 2001, p. 1294-1299 , PMID 11376176 ( neurology.org [accessed September 27, 2010]).

Individual evidence

  1. ↑ a b Axel Follmann: A mechatronic system for semi-active skull trepanation. Dissertation . RWTH Aachen University. Shaker Verlag, Aachen 2012.
  2. ↑ History of the Skull Orifices: Hole in the Head . In: epoc . No. 1 , 2005 ( Spektrum.de [accessed on October 9, 2016]).
  3. ^ V. Lehmann: Der Kayserliche Schnitt: the story of an operation. Schattauer Verlag, 2006, ISBN 3-7945-2494-2 , pp. 89ff. (on-line)