- 23 Sep 03:15
- Features of surgical intervention
- Indications for operation
- Contraindications to surgical intervention
- tool kit Preparation for operation
- Surgical access
- Conduct of operation
Surgical operations on the head represent a radicaland a rather dangerous method of surgical treatment and are carried outonly in those cases where there are no other effective methods of treatment, and the danger to a person's life is high. Under these notions there are different surgical interventions according to the degree of complexity, but they all cause serious concern.
Features of Surgical Intervention
Any surgical intervention in the human body is a direct impact instrument on the affected organ( tissue) for the purpose of treatment, correction or removal. The main types of exposure - disengaging, moving( removing) or connecting fabrics. Any operation is divided into 3 stages: provision of direct access to the area of injury, operational manipulation in the a
With the aim and degree of treatment, the operation can be radical( complete elimination of pathology), palliative( partial elimination of the cause of pathology) and symptomatic( does not eliminate the pathology, but facilitates the condition of the patient).Head surgery is divided into urgent, urgent( within 48 hours after the onset or detection of pathology) and planned when normal training and therapy are performed.
Scheme of surgical operation.
The scheme of any surgical operation includes the following main elements:
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Indications for Operation
The most common indication for an emergency head surgery is penetrating injuries and injuries;blockage of blood supply as a result of thrombus, stroke. Urgent operations are performed with intracranial bleeding, stroke, abscesses.
The first place among the causes of head surgery is severe brain injury and injury, both penetrating and non-penetrating. An indication for surgery may be ruptures of soft tissues, fractures and damage to the skull, brain edema, intracranial hematomas, vessel damage and internal bleeding.
The need for surgical intervention dictates the presence of primary and metastatic malignancies( brain cancer);including one of the most common types of the disease - glioma. An indication to the operation may be the detection of infection or the occurrence of edema that can cause a malignant tumor.
Operative treatment is prescribed in the pathological disorder in the vascular system of the brain, which causes the accumulation of blood mass in the membranes and the brain. The most dangerous arteriovenous malformia, intraventricular haemorrhage, carvenoma, vascular aneurysms. One of the causes of severe vascular disease can be a blow, after which the hematoma blocks the blood circulation. Urgent surgical intervention can save a person with hemorrhagic stroke. Sometimes, the operation is also indicated for an ischemic stroke type, if there is a dangerous narrowing of the vessels.
The purpose of the operation may be to eliminate abscess and abscess in the event of infection. Often the cause is hydrocephalus in the event of an infection in the cerebrospinal fluid, which initiates the expansion of the brain and requires the removal of excess fluid. Neurological surgery is also indicated in some cases in acute epileptic seizures.
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Contraindications toSurgical Intervention
There are a number of states of the patient when surgical intervention can be contraindicated and dangerous for his or her life. However, the contraindications should be evaluated taking into account the striking effect of craniocerebral pathology, that is, the doctors' congress must reliably assess what is more dangerous for life - possible complications or pathologies.
As contraindications to surgical head treatment, the following factors should be considered:
- is over 75 years old;
- dangerous diseases of the somatic type in the stage of decompensation - diabetes mellitus, renal, hepatic, cardiac or respiratory failure;
- expressed anomalies of blood clotting;
- acute purulent and oncological processes in other organs;
- is a dangerous state( coma, shock).
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When conducting operations on the head, a general surgical and special tool kit is used. The toolkit used for any surgical treatment includes:
- disassembles a tool( scalpels, scissors);
- hemostatic devices( clamps, ligature needles, dissector);
- couplers( needles, needle holders) and auxiliary tools( tweezers, probes, hooks, corkscands, syringes).
In the specialized set for intracranial operations involving trepanation of the skull, the following devices should be present:
- a circle with a set of milling and drill bits;
- splitters Dahlgren and Lümer;
- decompressors straight and bent;
- sponge bone Folkman;
- saw Djigli and Palenov's conductor;
- as well as an elevator, rasping, a set of scapular powders, a rubber pear, neurosurgical clamps.
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surgery Before carrying out the surgical procedures, the following recommendations must be followed:
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The first stage of the operation is to provide access to the focus of the injury, depending on the location and extent of the damage. With penetrating wounds( without damage to the skull), access is provided by spreading soft tissues and necessary cuts.
In the presence of purulent foci, abscesses in the frontal, temporal, parietal or occipital areas of the head without penetration under the solid membrane of the brain, appropriate sections of the skin and soft tissues in the pathology area are performed.
Deep depth depends on the size and location of the hearth.
At intracranial pathology, the trepanation of the skull( craniotomy) is performed, that is, the opening of the cranial box to provide access to the focus of the lesion. Craniotomy can be carried out in the form of bone-plastic or decompression trepanation. In the first case, surgical access is provided by removing scar tissue and a small area of the cranial bone, which returns to its place after the operation. The order of such trepanation is as follows: the stopping of blood flow in the tissues is removed by shaving the seam zone;a gradual cutting of the flap of soft tissues( cutting of skin with subcutaneous tissue, aponeurosis with muscles, periosteum);branching of the cranial bone and removing the bone marrow;Cutting of the solid cerebellum.
Decompression trepanation is of a palliative type and provides the opening of the cranial box and the reduction of intracranial pressure by lumbar puncture. To perform such an operation in the temporal bone, a hole is molded, which is expanded with bone nippers to the desired size;a small cross-sectional incision is made in the hard shell. Surgical impact is carried out on the part of the non-dominant hemisphere of the brain.
Modern surgery on the head is carried out using a high-precision navigation system, which allows you to pinpoint the scalpel of the surgeon, and precise methods of control - automatic and visual.
The work is carried out under a microscope using laser and ultrasonic "scalpels".Special precision of devices allows minimizing the area of cranial damage, and laser technology is able to easily handle blood vessels, preventing bleeding.