Exploring Cranial neurosurgery: A Comprehensive Guide

When it comes to cranial neurosurgery, understanding holds the key. This extraordinary branch of surgery plays a vital role in modern medicine, providing optimism and answers for individuals confronting diverse brain-related ailments. In this all-encompassing manual, let’s accompany UpSurgeOn to embark on a profound exploration of cranial neurosurgery, encompassing the intricacies of the procedures and potential challenges, to enlighten you about this captivating domain of medical expertise.

What is cranial neurosurgery? 

Cranial neurosurgery, also known as neurological surgery, is a highly specialized field of medicine that focuses on the brain and its surrounding structures within the skull. This incredible discipline covers a wide range of diagnoses and treatments, from brain tumors to vascular disorders, traumatic brain injuries, infections, and neurological disorders. The techniques used in cranial neurosurgery are as varied as the conditions they treat, including craniotomy, tumor removal, brain biopsy, aneurysm clipping, and the placement of shunts or implants.

The ultimate goal of cranial neurosurgery is to alleviate distressing symptoms, improve brain function, and, in some cases, eliminate or manage the underlying conditions that affect patients [1] [2].

Indications for cranial neurosurgery

Patients who could potentially benefit from cranial neurosurgery frequently exhibit a combination of symptoms that require immediate attention to restore their overall health and well-being. These symptoms act as warning signs, signaling the need for a comprehensive assessment and potential surgical intervention. Some of these indicators comprise:

• Headaches: Persistent or severe headaches that are not relieved by over-the-counter pain medications may be a symptom of an underlying condition that requires neurosurgical intervention.
• Seizures: Recurrent seizures or seizures that are difficult to control with medication may indicate the need for cranial neurosurgery to remove or treat the source of the seizures.
• Neurological deficits: Symptoms such as weakness, numbness, difficulty speaking or understanding speech, vision problems, balance issues, or changes in coordination may be indicative of a condition that requires surgical intervention.
• Cognitive or behavioral changes: Sudden or progressive changes in cognition, memory, mood, or behavior may be associated with conditions such as brain tumors or hydrocephalus, which may require cranial neurosurgery.
• Vision problems: blurred vision, double vision, loss of peripheral vision, or other visual disturbances may be a sign of a condition affecting the optic nerves or other structures in the brain that may require surgical treatment.
• Balance and coordination problems: Difficulty with balance, coordination, or walking may be a symptom of conditions such as brain tumors or Chiari malformations, which may require surgical intervention.

It is essential to keep in mind that these symptoms may be linked to various underlying conditions, necessitating a comprehensive evaluation and a thorough diagnosis to determine the appropriateness of cranial neurosurgery [3 –10].

Common procedures in cranial neurosurgery 

Cranial neurosurgery encompasses a spectrum of procedures tailored to address the unique needs of each patient. These procedures are highly specialized and chosen with great care, taking into consideration the individual’s condition and overall assessment. Some common procedures include:

• Craniotomy: A surgical procedure in which a part of the skull is temporarily removed to expose the brain and perform intracranial procedures such as tumor removal, aneurysm repair, and hematoma evacuation. [11]
• Cranioplasty: A procedure performed after a craniectomy (removal of a part of the skull) to reconstruct and replace the bone flap back into the skull. It restores the natural cosmesis and protective barrier of the skull. [12]
• Stereotactic procedures: These procedures use a three-dimensional coordinate system to precisely target and treat brain lesions, such as tumors or functional abnormalities. They may involve techniques like stereotactic biopsy, stereotactic radiosurgery, or deep brain stimulation [13].
• Endoscopic procedures: minimally invasive techniques that use an endoscope to access and treat intracranial pathologies. They can be used for tumor resection, cyst drainage, or treatment of hydrocephalus. [14]
• Skull base surgery: complex procedure that involves accessing and treating tumors or abnormalities at the base of the skull, which can be challenging due to the intricate anatomy and proximity to critical structures. Various surgical approaches and techniques are used, depending on the location and type of pathology [14].

The selection of a specific procedure is made after a thorough assessment and is tailored to the patient’s unique needs and condition. Each procedure carries its own set of risks and benefits, highlighting the importance of individualized care.

Most common cranial neurosurgeries

Cranial neurosurgery encompasses a wide array of sub-specialties, each dedicated to addressing specific conditions. The most common cranial neurosurgeries include:

• Cerebrovascular procedures: These involve the treatment of conditions affecting the blood vessels in the brain, such as aneurysms, arteriovenous malformations (AVMs), and carotid artery stenosis.
• Neuro-oncology procedures: These involve the surgical treatment of brain tumors, including meningiomas, gliomas, and metastatic brain tumors.
• Functional neurosurgery procedures: These procedures are performed to treat conditions that affect the function of the nervous system, such as deep brain stimulation for movement disorders like Parkinson’s disease and epilepsy surgery for drug-refractory epilepsy.
• Skull base procedures: These procedures are performed to treat tumors and other conditions that affect the base of the skull, which is a complex area with important structures like cranial nerves and blood vessels. Skull-base meningiomas are examples of conditions that may require surgical intervention [15], [16].

Possible Complications in Cranial Neurosurgery

• Hemorrhage: Bleeding can occur during or after surgery, leading to complications such as hematoma formation or increased intracranial pressure [17].
• Infection: Surgical site infections can occur, leading to wound complications, meningitis, or brain abscesses [17].
• Cerebrospinal fluid (CSF) leakage: CSF leakage can occur due to dural tears or inadequate closure, which may require additional surgical intervention [18].
• Neurological deficits: complications such as cranial nerve palsies, seizures, or ischemic infarction can occur, leading to neurological decline [19].
• Brain edema: Swelling of the brain tissue can occur after surgery, leading to increased intracranial pressure and potential complications [19].
• Hydrocephalus: Disturbances in cerebrospinal fluid circulation can lead to the accumulation of fluid in the brain, requiring further management [20].
• Bone flap complications: In procedures involving craniotomy or craniectomy, complications related to the bone flap, such as bone flap infection, bone flap resorption, or bone flap displacement, can occur [17] [21].
• Complications specific to decompressive craniectomy: In decompressive craniectomy procedures, complications such as herniation through the cranial defect, subdural hygromas, or the syndrome of the trephined (a new cognitive, neurological, or psychological deficit) can occur [22] [23].
• Hardware-related complications: Complications related to the implanted hardware, such as infections, malposition or migration of leads, component fracture or malfunction, or loss of desired effect, can occur [24].

Conclusion

In the realm of cranial neurosurgery, knowledge and understanding are paramount. With this comprehensive guide, UpSurgeOn aims to equip you with the information you need to navigate the complexities of this fascinating field. Whether you’re a patient seeking answers or a medical professional seeking insights, our guide offers a deep dive into the world of cranial neurosurgery, from its indications to common procedures and potential complications. It’s our mission to provide you with the knowledge required to make informed decisions in the realm of cranial neurosurgery. Let’s delve deeper into the world of neurosurgery knowledge with UpSurgeOn Academy and enhance your training through our cutting-edge simulations. Embark on this transformative journey with us today and unlock the secrets of your surgical evolution.

References: 

1. Elsabeh, R., Singh, S., Shasho, J., Saltzman, Y., & Abrahams, J. M. (2021). Cranial neurosurgical robotics. British Journal of Neurosurgery, 35(5), 532–540. https://doi.org/10.1080/02688697.2021.1950622
2. Kwinta, B., Krzyżewski, R. M., Kliś, K. M., Donicz, P., Gackowska, M., Polak, J., Stachura, K., & Moskała, M. (2017). Emergency reoperations in cranial neurosurgery. World Neurosurgery, 105, 749–754. https://doi.org/10.1016/j.wneu.2017.06.090
3. Fugate, J. E. (2015). Complications of neurosurgery. Continuum, 21, 1425–1444. https://doi.org/10.1212/con.0000000000000227
4. Westerlund, U., Linderoth, B., & Mathiesen, T. (2011). Trigeminal complications arising after surgery of cranial base meningiomas. Neurosurgical Review, 35(2), 203–210. https://doi.org/10.1007/s10143-011-0355-0
5. Donovan, D. J., Moquin, R. R., & Ecklund, J. M. (2006). Cranial burr holes and emergency craniotomy: review of indications and technique. Military medicine, 171(1), 12-19.
6. Ibrahim, A., Auguste, K. I., Vachhrajani, S., Dirks, P. B., Drake, J. M., & Rutka, J. T. (2009). Neurosurgical management of intracranial epidermoid tumors in children. Journal of Neurosurgery, 4(2), 91–96. https://doi.org/10.3171/2009.4.peds08489
7. De Oliveira, M. F., Yamashita, R., Sorte, A. a. B., Rotta, J. M., Norremose, K. A., Teixeira, M. J., & Pinto, F. C. G. (2020). Psychiatric symptoms are frequent in idiopathic intracranial hypertension patients. Neurosurgical Review, 44(2), 1183–1189. https://doi.org/10.1007/s10143-020-01321-3
8. Ferguson, S. D., Levine, N. B., Suki, D., Tsung, A. J., Lang, F., Sawaya, R., Weinberg, J. S., & McCutcheon, I. E. (2018). The surgical treatment of tumors of the fourth ventricle: a single-institution experience. Journal of Neurosurgery, 128(2), 339–351. https://doi.org/10.3171/2016.11.jns161167
9. Cler, S. J., Sharifai, N., Baker, B., Dowling, J. L., Pipkorn, P., Yaeger, L., Clifford, D. B., Dahiya, S., & Chicoine, M. R. (2021). IGG4-Related Disease of the Skull and Skull Base–A Systematic Review and Report of two cases. World Neurosurgery, 150, 179-196.e1. https://doi.org/10.1016/j.wneu.2021.03.054
10. Wang, X., Song, G., Chen, G., Guo, H., Li, M., Liang, J., & Bao, Y. (2018). Single-Center Clinical Characteristics and Treatment experience of foramen magnum neurenteric cyst: Report of 6 cases and Brief review of the literature. World Neurosurgery, 112, e608–e616. https://doi.org/10.1016/j.wneu.2018.01.097
11. Craniotomy. (2023c, January 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/32809757/
12. Piazza, M., & Grady, M. S. (2017). Cranioplasty. Neurosurgery Clinics of North America, 28(2), 257–265. https://doi.org/10.1016/j.nec.2016.11.008
13. Elsabeh, R., Singh, S., Shasho, J., Saltzman, Y., & Abrahams, J. M. (2021b). Cranial neurosurgical robotics. British Journal of Neurosurgery, 35(5), 532–540. https://doi.org/10.1080/02688697.2021.1950622
14. Zada, G., Başkaya, M. K., & Shah, M. V. (2017). Introduction: surgical management of skull base meningiomas. Neurosurgical Focus, 43(videosuppl2), Intro. https://doi.org/10.3171/2017.10.focusvid.intro
15. Ryu, W. H. A., Yang, M., Muram, S., Jacobs, W. B., Casha, S., & Riva-Cambrin, J. (2018). Systematic review of health economic studies in cranial neurosurgery. Neurosurgical Focus, 44(5), E2. https://doi.org/10.3171/2018.2.focus17792
16. Zada, G., Başkaya, M. K., & Shah, M. V. (2017b). Introduction: surgical management of skull base meningiomas. Neurosurgical Focus, 43(videosuppl2), Intro. https://doi.org/10.3171/2017.10.focusvid.intro
17. Chughtai, K., Nemer, O., Kessler, A. T., & Bhatt, A. A. (2018). Post-operative complications of craniotomy and craniectomy. Emergency Radiology, 26(1), 99–107. https://doi.org/10.1007/s10140-018-1647-2
18. Dubey, A. K., Sung, W. S., Shaya, M., Patwardhan, R. V., Willis, B. J., Smith, D. R., & Nanda, A. (2009). Complications of posterior cranial fossa surgery—an institutional experience of 500 patients. Surgical Neurology, 72(4), 369–375. https://doi.org/10.1016/j.surneu.2009.04.001
19.  Fugate, J. E. (2015b). Complications of neurosurgery. Continuum, 21, 1425–1444. https://doi.org/10.1212/con.0000000000000227
20. Shepetovsky, D., Mezzini, G., & Magrassi, L. (2021). Complications of cranioplasty in relationship to traumatic brain injury: a systematic review and meta-analysis. Neurosurgical Review, 44(6), 3125–3142. https://doi.org/10.1007/s10143-021-01511-7
21. Yang, X., Wen, L., Shen, F., Li, G., Lou, R., Liu, W. G., & Zhan, R. (2008). Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochirurgica, 150(12), 1241–1248. https://doi.org/10.1007/s00701-008-0145-9
22. Stiver, S. I. (2009). Complications of decompressive craniectomy for traumatic brain injury. Neurosurgical Focus, 26(6), E7. https://doi.org/10.3171/2009.4.focus0965
23. Kurland, D. B., Khaladj-Ghom, A., Stokum, J. A., Carusillo, B., Karimy, J. K., Gerzanich, V., Sahuquillo, J., & Simard, J. M. (2015). Complications Associated with Decompressive Craniectomy: A Systematic Review. Neurocritical Care, 23(2), 292–304. https://doi.org/10.1007/s12028-015-0144-7
24. Fenoy, A. J., & Simpson, R. K. (2014). Risks of common complications in deep brain stimulation surgery: management and avoidance. Journal of Neurosurgery, 120(1), 132–139. https://doi.org/10.3171/2013.10.jns131225