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Craniotomy for Intracerebral Hematoma

Overview: This procedure, performed under general anesthesia, creates an opening through the skull for removal of a blood clot inside the brain. Intracerebral hematomas can result from trauma to the head. They can also occur spontaneously in patients with abnormally high blood pressure, or a blood vessel abnormality. Intracerebral hematomas can place harmful pressure on the brain.

Preparation: In preparation for the procedure, the patient is anesthetized and all or a portion of the scalp may be shaved. The patient’s head is secured to prevent movement.

Accessing the Hematoma: The surgeon creates a long, arched incision in the scalp above the hematoma. The soft tissue is folded back to expose the skull. The surgeon drills one or more small holes into the skull and then saws between the holes to free a section of bone. This ‘skull flap’ is removed and stored. The surgeon carefully opens the dura, the membrane that surrounds the brain, allowing access to the brain tissue. Removing the Hematoma The surgeon uses instruments to carefully move aside brain tissue, exposing the hematoma. A suction device is used to remove the hematoma. Areas around the hematoma that continue bleeding will be cauterized.

End of Procedure: Once the hematoma has been removed, the instruments are removed and the dura is closed. The skull flap may be put back into place and anchored with plates and screws. If the patient has experienced severe brain swelling, the bone flap may need to be left out temporarily and reattached during a second procedure several weeks later. In some cases, a temporary drain may be placed at the surgical site to prevent fluid buildup. The skin flap is folded back and closed with sutures or surgical staples.

Aftercare: Most patients who have had a craniotomy for intracerebral hematoma must remain in the ICU for at least a few days, and sometimes several days. The prognosis for recovery depends on the location and size of the hematoma. Many patients have some residual neurologic disability even after an intracerebral hematoma is removed, because the surgery can’t repair the damage that the hematoma has already caused to the brain tissue.