Getting used to craniectomy

Hi all,

I am currently doing my Neurosurgical Inpatient Placement. It has been quite an eye-opener for first week.

This is the first time I am in close contact with traumatic head injured patients. To tell the truth, I was a little taken aback to what I have seen this week. Comparing to the picture I had in mind (after sitting through those traumatic HI lectures and seeing pictures of them in the rehabilitation phase) of how they may behave or look, there is a vast difference to the reality.

There are some patients who have had craniectomy (skull taken out), where there is not just a hollow dip in the head. There may be cerebrospinal leakage, occupying the area where the skull has been removed, making it look boggy and it is really soft and malleable to touch. I really do not know how to describe it, but to say it seems really “squishy”. I got a little freaked out when I do see and feel the fluid move. Most of us have got something that “eeks” us out and probably this is it for me. Think I will need some time to get used to it.

I had to help to sit this patient with a frontal craniectomy up on the edge of the bed. As the patient did not have any neck control, it was necessary to support the head. Besides, patient has a trachy on, so it was crucial that his head was not in an overly flexed position in case he coughs on it. The tricky bit to it was that there was very little bony surface that I could hold onto. There was no bone at the forehead and I could only support 1 finger width above the eyebrows where the edge of the craniectomy was. Another hand had to be right above the mid of the skull. I then realized that a human’s head is really heavy to support. All those brain matter really weigh a ton, and in addition to that, the excess CSF fluid. It is an uphill task trying to keep the patient’s head up in neutral. By the end of the placement I would expect good development of my UL musculature.

Hopefully this will give those going into neurosurgical inpatient, who may be freaked out like I was, a little mental preparation. Although I am sure most would take it really well. Despite the not-so-appealing part of it, I think I will still have plenty to look forward to for the next 3 weeks.