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Kraniektomia – wskazania i możliwe powikłania

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Kraniektomia to operacja, która polega na rozcięciu czaszki i wytworzeniu płata kostnego, który następnie zostaje usunięty, dzięki czemu chirurg zyskuje dostęp do mózgowia. Kiedy i w jaki sposób się ją wykonuje i jakie mogą być powikłania tego zabiegu?

Jakie są wskazania do kraniektomii?

Kraniektomia to metoda leczenia podwyższonego ciśnienia śródczaszkowego oraz obrzęku mózgu spowodowanego urazem czaszkowo-mózgowym lub schorzeniem neurologicznym. Wykonanie kraniektomii powoduje wytworzenie przestrzeni, która jest wypełniana przez obrzęknięty mózg. Procedura skutkuje natychmiastowym i trwałym obniżeniem ciśnienia wewnątrzczaszkowego.

Kraniektomię stosuje się m.in. w leczeniu złośliwych udarów niedokrwiennych tętnicy środkowej mózgu, łagodnych guzów mózgu, skurczów naczyniowych po krwawieniu podpajęczynówkowym.

Jak przebiega kraniektomia?

W przebiegu kraniektomii dochodzi do otwarcia czaszki, usunięcia płata kostnego i przecięcia opony twardej, w miejsce której wszywa się plastykę utworzoną np. z okostnej czaszki.

Kraniektomia może zostać przeprowadzona z wykorzystaniem zróżnicowanych metod i na różnych częściach czaszki. Wyróżnia się kraniektomię podskroniową, dwuczołową, czołowo-skroniowo-ciemieniową oraz podpotyliczną. Kraniektomia może mieć formę jednostronną lub dwustronną.

Najczęściej wykonuje się kraniektomie jednostronne czołowo-skroniowo-ciemieniowe oraz kraniektomie dwuczołowe.

Jakie są rodzaje kraniektomii?

W literaturze naukowej wyróżnia się trzy rodzaje kraniektomii.

Rodzaj pierwszy to kraniektomia wczesna, którą wykonuje się w celu zmniejszenia pourazowego obrzęku mózgu, któremu nie towarzyszą inne pourazowe zmiany wewnątrzczaszkowe.

Rodzaj drugi to kraniektomia profilaktyczna lub pierwotna. Przeprowadza się ją u pacjentów, u których wystąpiły zmiany pourazowe takie jak np. krwiak podtwardówkowy. Kraniektomia ma w tym przypadku na celu zapewnienie dodatkowej przestrzeni, którą mogą wypełnić obrzęknięte po urazie tkanki mózgu. Zapobiega to wystąpieniu wzmożonego ciśnienia wewnątrzczaszkowego i związanych z nim powikłań.

Ostatni rodzaj kraniektomii to kraniektomia późna, wykonywana w przypadku obrzęku mózgu, który narasta pomimo stosowania zachowawczych metod leczenia.

Jakie powikłania mogą wystąpić po kraniektomii?

Najczęstsze powikłania po operacji kraniektomii to wodniaki i krwiaki nad- oraz podtwardówkowe, które w większości przypadków nie wymagają interwencji neurochirurgicznej. Wśród innych możliwych powikłań wymienia się wodogłowie, stłuczenia mózgu, ostre przeciwstronne krwiaki podtwardówkowe, krwawienia do pnia mózgu.

Po wykonaniu plastyki kości czaszki w następstwie kraniektomii może dojść do infekcji oraz rozpuszczenia autogennej kości po reimplantacji. W rzadkich przypadkach notuje się wystąpienie pooperacyjnych napadów drgawek i zakrzepic żylnych.

Źródło: P. Jasielski, „Optymalne warunki kraniektomii odbarczającej w leczeniu chorych z urazami czaszkowo-mózgowymi”, Instytut Medycyny Doświadczalnej i Klinicznej im. M. Mossakowskiego PAN w Warszawie, Warszawa 2014.

 

Przeczytaj także: Pierwsza pomoc przy oparzeniu chemicznym przełyku

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