Step–by–Step Craniotomy Procedure for Brain Aneurysm Clipping Explained | Dr Ramakrishna Chowdhary
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Step–by–Step Craniotomy Procedure for Brain Aneurysm Clipping Explained | Dr Ramakrishna Chowdhary |
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Video From Arete Hospitals |
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This Video Uploaded At 19-03-2025 11:30:33 |
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In this video, Dr Ramakrishna Chowdhary, HOD -Neurosurgery, Arete Hospitals, Gachibowli, Hyderabad, walks us through Craniotomy - life-saving brain surgery carried out on a 52-year-old patient who had been presented at the hospital with severe headache and multiple episodes of vomiting.
Step–by–Step Craniotomy Procedure for Brain Aneurysm Clipping Explained
The doctor shares an in-depth explanation of the craniotomy procedure from patient positioning to aneurysm clipping and post-operative care.
The doctor explained that the patient suffered from severe headache and bouts of vomiting. She was conscious alert and obeying commands, but she had a severe headache. After an internal discussion on the management, the doctor's team decided to go ahead with a CT Angiography of the brain (CT Angio brain) which showed an aneurysm arising from the distal anterior Cerebral artery that is not a commonly seen location for the aneurysm in the brain. Then the management was discussed, and the team went ahead with microsurgical clipping of the aneurysm by craniotomy
*What is Craniotomy?*
A Craniotomy is a surgical procedure that involves removing a portion of the skull to access the brain.
*The Craniotomy Procedure included the following steps(as explained by the doctor)*
➢ A navigation-guided craniotomy was planned to clip the aneurysm.
➢ The patient was kept in a supine position with head fixation in the Sugita frame for head fixation and
➢ A left frontal craniotomy (Cranial bone) removal to provide maximum exposure of the aneurysm site
➢ A scalp incision was made and elevated to expose the cranial bone
➢ The Cranial bone flap, about 3 to 3.5 cm, was carefully removed
➢ The midline was exposed and provided access to the Corpus Callosum and nearby vasculature
➢ The dura was opened to expose the intermission fissure that was dissected while carefully navigating the arachnoid plains to reach the corpus callosum and both A2 and A3 branches and followed the A3 branches to expose the anterior cerebral artery where we had the aneurysm
➢ The aneurysm at the A3 segment of the anterior cerebral artery was dissected while preserving the surrounding vasculature
➢ Temporary control of the colossal artery was taken for safer dissection
➢ The aneurysm was made supple and dissected while safeguarding the vasculature around and completely clipped the aneurysm
➢ The clip was put to the neck of the aneurysm and completely isolated the aneurysm from normal circulation
➢ An indocyanine Green or ICG was performed to confirm complete obliteration of the aneurysm, along with vasculature maintenance
➢ The dura mater was closed properly
➢ The cranial bone flap was repositioned and secured and the flap closed
➢ The doctor concludes by explaining that the management of intracranial aneurysms is one of the critical emergencies in neurosurgery.
*Factors on which the outcome of the intracranial aneurysms depends*
The outcome of the intracranial aneurysms depends mainly on three factors
➢ one is early diagnosis of the ruptured aneurysm
➢ Secondly, the timely intervention, either by endovascular coiling or surgical clipping of the aneurysm, that is, complete isolation of the aneurysm from the normal circulation
➢ The third factor is good post-operative ICU care
Once the aneurysm is completely excised, the complications are less than 1% but despite the best surgical efforts by clipping the aneurysm or coiling the aneurysm still, complications can occur in the ICU. That's why good post-operative ICU care and continuous monitoring in the ICU are required to give good outcomes to patients.
*Time Codes:*
00:00 Doctor Introduction
0:08 Patient Brief
0:45 What is Craniotomy?
0:53 The Craniotomy Procedure Steps
3:54 Factors on which the outcome of the intracranial aneurysms depends
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