Tuesday, July 12, 2011

How many millihelen is your craniotomy?

Beauty, they say, lies in the eyes of the beholder. If one wants to be technically accurate, aesthetic appreciation centre of the human brain is perhaps the medial orbito-frontal cortex [neuro­bi­ol­o­gist Semir Zeki's fMRI study]. Human brain appreciates beauty looking primarily for symmetry and congruence when it compares a given pattern with those in its memory that once evoked a pleasurable sensation.

So if one Helen is the unit of beauty that could launch a thousand ships, how many millihelen is your craniotomy?

So, what do we do routinely to preserve aesthetics in neurosurgery?

Shaveless craniotomy, sinusoidal stealth incision, bone flap fixation implants, burrhole buttons, minimal access or natural foramen access (endoscopic endonasal), or may be, avoid a scalp incision altogether as in radiosurgery/endovascular surgery…to name a few

How important do you think aesthetics is in neurosurgery (assuming equivalent care inside the brain too) and could you suggest a few tips which one could use in routine practice? Or do you think it is not that much of a concern as in Westerners? I myself had many patients preferring to have a ‘full head shave’!

Cheers,
Gopalakrishnan.

Responses copied from yahoo group site:

Re: [neurosurgery_nimhans] How many millihelen is your craniotomy?

Very interesting topic of discussion I must say. I agree about the cosmetic benefits of non-shaved craniotomy. Wound care does however become a little more frustrating...and people often complain of increased wound infection rates. At TMH I did a small prospective study looking at infection rates following non shaved surgeries. we had about 75 tumor craniotomies. We also looked at scalp swabs before and after scrubbing in these patients....and I devised a VAS based 4 point questionairre for assessing cosmetic outcome also...The results are still being anlysed and maybe I can update you all in a short while. On preliminary look we did not find a higher infection rate.
If I may ask, what are the wound infection rates at your centres....though I don't have exact figures my experience shows it to hover around the 5-10% mark. A lot of them are related to wound leaks and I have a feeling (though no objective evidence) that by fixing the bone flap the leaks decrease and so also the infections.
Also, what antibiotic policy do you all follow (which antibiotic and for how long). These may sound very mundane issues, but I think they are as much crucial to the overall outcome .

Ali

Sent: Wednesday, July 13, 2011 1:25 PM
Subject: Re: [neurosurgery_nimhans] How many millihelen is your craniotomy?
 
Hi Gopal,
this is a good topic u asked for.
We started practising preserving hair for all kinds of craniotomy since 4 yrs and the response from the patients is very good especially from the xx chromosomes.
some of the patients went back to working early because of good aesthetic look because u have taken care of it.
regarding burrhlole buttons -- the cost factor adding to overall budget makes us use it less as compared to preserving hair. some patients do complain of deppression at burrhole sites especially chronic SDH.
bone fixation --- frontal region -yes good for cosmesis and other areas depending on the budget.

overall if u take care of cosmesis for the people, its an additional bonus.
  Dr.Praveen Ganigi
MBBS MCh Neurosurgery
Consultant Neurosurgeon & Spine Surgeon
Manipal Hospital,
HAL Airport road
Bangalore-560017