I mean, I suppose we can get back on track with where we left off before!! Which is right at the cranioplasty!!
They put in the notes that they are repairing my skull defect with synthetic (acrylic) materials. They also did a ventricular tap and it measured out to be 5-8cm mmHg! Which is the normal range. A ventricular tap is a drain they use to drain out cerebrospinal fluid with those suffering from hydrocephalus. It is also a great way to monitor the intracranial pressure.
During my hospital stay I got to wear a sweet bracelet that said, "at risk for falls." Boy, do I feel YOUNG. Said sarcastically, of course.
I did have a headache after my surgery, but it was manageable! I was able to communicate with the team that my diet has been slowly advancing. I can swallow thick liquids and I can eat soft bite-sized foods. The nurse stayed with me while I very slowly ate breakfast. I also had to push up the left side of my lips to get a drink. I still couldn't use a straw at this time because of my facial paralysis! They could tell that I'm weaker on my left side. My husband did let them know that he sees a slow improvement of my left side getting stronger though. He also let them know I am in Speech to work on my dysarthria and my dysphagia.
Dysarthria is slurred speech affected by a lack of muscle control in the face.
Dysphagia is when you have difficulty swallowing.
To this date, these are still strong issues for me!!
After this surgery, there was a new small volume juxtacortical hemorrhage in my left frontal lobe. They noted there is also a cranial nerve deficit present. They also made sure to note my left facial droop!! I also have III & VI nerve palsies. At this point, I have a Duval drain attached to my head to suction out any excess fluid and the small hemorrhage!
I also told them that I wanted to be discharged with my husband and he is the only person that takes care of me.
The massive head wrap they have on my head needs to stay ON MY HEAD for up to three days. Then we can slowly and carefully remove it. I can then shower and clean my scalp. You know...since I'm bald! My husband will inspect it daily for the next couple of weeks to make sure it is not red and swelling.
My doctor's post-op diagnosis for me is...drumroll please...SEVERE TRAUMATIC BRAIN INJURY! I feel like I should get a sticker. Maybe some cookies.
This was a picture of my skull/brain BEFORE the surgery:
And now... the procedure! I know, the moment you ALL have been waiting for!!
After identifying Jessica D and confirming the appropriate site and procedure in the preoperative holding area, the patient was taken to the OR. The patient was transferred to the operating table and positioned in the supine position following induction of general anesthesia and endotracheal intubation. The incision was planned over the prior bifrontal craniectomy incision. The head was shaved. The surgical area was then prepped and draped in the usual sterile fashion. A total of 20 mL of 0.5% ropivacaine with epinephrine was injected underneath the skin for local anesthesia and hemostasis at the planned incision site. Intraoperative Stealth was registered. A time out was then performed.
A #10 skin scalpel was used to incise the skin and carried down to the dural scar. We were aided by the use of a key elevator, monopolar cautery, and Metzenbaum scissors, which were used to dissect under the dermis and protect the underlying dura/brain was we carried the incision down to the bony edges of the prior craniectomy. The temporalis muscle/fascia was carefully pulled away from the dural substitute, and the scalp was gently reflected anteriorly. Raney clips were applied. There were two dural defects that were repaired with 3-0 Vicryl.
The left PEEK bone flap was brought into the field. We had previously placed it using the Stryker Cranial plating system. It was fixed in place with 4 points of fixation. Attention was then directed to the ventricular puncture. Using AXIOM Stealth guidance, a ventricular catheter was directed into the right lateral ventricle, moderate CSF flow was appreciated. A manometer was attached to the end of the ventricular catheter, and kept at the level of the tragus, pressures were appreciated to be 5-8 cmH2O. The ventricular catheter was removed, and a muscle graft was placed into the catheter insertion site. Following this, the right PEEK bone flap was brought into the field, this was fixed in place with 4 points of fixation.
We were satisfied with our fixation. We then turned our attention to closure. The wound was then copiously irrigated with normal saline with bacitracin. A single subgaleal hemovac was placed and secured with a 2-0 Nylon. We used 2-0 and 3-0 inverted interrupted Vicryl stitches for galea, and 2-0 Nylon for skin. Bacitracin and a sterile headwrap were applied. All needle and sponge counts were correct at the end of the case. The patient was then transported back to the hospital bed, extubated without incident and transported to PACU.
And a picture of my brain AFTER the surgery!
The white spots are where the brain was hemorrhaging! The amazing surgery that got rid of my helmet. Now we are putting it in a glass football case to put it on display!
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