The perioperative nurse in the circulating role is planning for her three neurosurgical procedures for the day.She is explaining the basic processes of the three procedures to the scrub person: (1)exploration of a severe head injury with increased intracranial pressure (ICP)to evacuate a hematoma and possible excision of brain tissue,(2)a VP shunt insertion,and (3)a reconstructive craniosynostosis procedure for an infant with severe deformity.To give the brain room to swell in the first procedure,the bone flap may need to be sterile-wrapped and stored for later replacement.What is the appropriate surgical approach to the brain for each of the procedures?

Question

Quizplus · Accepted Answer

A burr hole is the minimum exposure made to gain access to the brain.Burr holes are necessary for many neurosurgical procedures and can be used to access the intracerebral ventricles for the placement of a ventricular catheter (VP shunt)to drain obstructed cerebrospinal fluid (CSF).Craniectomy is the permanent removal of a section of the cranium using burrs and rongeurs to enlarge one or more burr holes.The surgeon performs a craniectomy to gain access to the underlying structures.Craniectomy is indicated as treatment for craniosynostosis in infants and young children.A craniotomy is the removal of a section of the cranium referred to as a bone flap.One or more burr holes are placed,and the dura is dissected away from the cranium A craniotomy may be performed to evacuate intracranial hematomas,tumors,or vascular lesions not accessible through a burr hole.The bone plate may be separated from the soft tissues,removed from the skull,and set aside for replacement at the end of the procedure.If intracranial swelling at the end of the procedure is a major concern,the bone plate may be frozen and stored in a sterile container according to hospital protocol to be used on the patient at a future date when the reduced ICP and swelling permits.

The Perioperative Nurse in the Circulating Role Is Planning for Her