From the Guidelines
The recovery process after a craniotomy is a complex and individualized process that involves careful management of postoperative complications, such as wound dehiscence, hydrocephalus, and infection, as well as rehabilitation and follow-up care.
Postoperative Care
- Patients may require tracheostomy and gastrostomy for management in the initial postoperative phase 1
- Cranioplasty may be necessary after decompressive craniectomy, but the timing of this procedure remains unknown 1
- Hyperosmolar therapy may be indicated for cerebral edema 1
Rehabilitation and Follow-up
- Patients may experience residual permanent disabilities after decompressive craniectomy for supratentorial infarction with swelling 1
- Neurological monitoring and management are crucial for patients undergoing decompressive craniectomy, particularly those on extracorporeal membrane oxygenation (ECMO) 1
- Multidisciplinary care is essential for discussing the risks and benefits of decompressive craniectomy and for providing individualized care to patients 1
Key Considerations
- Decompressive craniectomy may be indicated in patients with space-occupying lesions with acute intracranial hypertension, such as hemispheric infarction with malignant edema 1
- Systemic anticoagulation monitoring and resumption are necessary post-operatively 1
- The timing of cranioplasty after decompressive craniectomy remains unknown, but the complication rate may be higher in early cranioplasty, particularly in patients with a ventriculoperitoneal shunt at the time of cranioplasty 1
From the Research
Recovery Process After Craniotomy
The recovery process after a craniotomy can vary depending on several factors, including the type of surgery, the patient's overall health, and the presence of any complications.
- The time to return to activities of daily living (ADL) after craniotomy for brain tumors can range from a few weeks to several months, with over 89% of patients performing basic ADL items within a month and instrumental ADL items within 2 months 2.
- The application of enhanced recovery after surgery (ERAS) measures can promote postoperative rehabilitation in patients with brain tumors undergoing craniotomy, reducing the time of urinary catheter removal, the time to start ambulation, and the hospital length of stay (LOS) 3.
- Cranioplasty, a surgical intervention for repairing cranial defects, may also improve motor and neuropsychological function, including language recovery, in patients with severe aphasia 4.
Enhanced Recovery After Surgery (ERAS)
ERAS protocols have been shown to improve outcomes and quality of life in patients undergoing craniotomy for brain tumors, with significant reductions in postoperative LOS, pain, and postoperative nausea and vomiting (PONV) 5.
- Implementing ERAS protocols may also improve patient satisfaction and quality of life, with one study showing greater patient satisfaction at 30-day follow-up 5.
- A protocol for postoperative admission of elective craniotomy patients to a non-ICU or step-down setting has been developed, allowing for safe management of patients outside the ICU in the postoperative period 6.
Postoperative Care
Postoperative care for patients undergoing craniotomy can be safely managed on a neurosurgical floor after 4 hours of recovery in the postanesthesia care unit (PACU), with criteria including hemodynamically stable adults without significant new postoperative neurological impairment 6.
- This care pathway has been shown to be safe, with no major complications or permanent morbidity or mortality reported in a study of 200 consecutive patients 6.