Ensure a thorough and detailed assessment of the patient's overall health and medical history to establish a baseline for the procedure. This includes reviewing any medications, allergies, and previous surgeries. The pre-operative assessment helps in identifying any potential risks or complications and enables the medical team to make necessary adjustments or precautions. The desired result is to have a comprehensive understanding of the patient's current condition and any potential risks or concerns that may affect the surgery. It requires medical knowledge and expertise, effective communication with the patient, and access to medical records and diagnostic test results.
1
Physical examination
2
Laboratory tests
3
Imaging studies
4
Cardiac evaluation
5
Anesthesia assessment
1
Hypertension
2
Diabetes
3
Cardiovascular disease
4
Respiratory disease
5
Renal disease
Ensure consent has been obtained
Verify that the patient has provided informed consent for the Extracranial-Intracranial Bypass Procedure. Consent forms should be signed and documented prior to the surgery, confirming that the patient understands the nature of the procedure, associated risks, and potential outcomes. This task ensures compliance with legal and ethical requirements and upholds patient autonomy. The desired result is to have a legally valid and ethically sound consent documentation. It requires effective patient communication, explanation of the procedure, addressing any concerns or questions, and signing of the consent form.
1
General Consent
2
Specific Consent
3
Emergency Consent
4
Proxy Consent
5
Pediatric Consent
Perform patient positioning
Position the patient in a suitable and safe manner to facilitate the access and visualization of the surgical site during the Extracranial-Intracranial Bypass Procedure. Proper patient positioning is crucial for optimal exposure, accessibility, and support throughout the surgery. The desired result is a comfortable and secure patient position that allows the surgical team to perform the procedure effectively and minimize any potential complications. It requires knowledge of surgical positioning techniques, consideration of patient comfort and safety, and collaboration with the anesthesia team.
1
Supine
2
Prone
3
Lateral
4
Sitting
5
Semi-Fowler's
1
Pillow/Pad
2
Safety straps
3
Arm boards
4
Footboard
5
Headrest
Initiate anesthesia administration
Start the administration of anesthesia to induce a controlled state of unconsciousness and analgesia, ensuring patient comfort, pain relief, and maintaining physiological stability during the Extracranial-Intracranial Bypass Procedure. Anesthesia plays a crucial role in ensuring a safe and comfortable surgical experience for the patient and optimal operating conditions for the surgical team. The desired result is a well-induced anesthesia with minimal side effects or complications. It requires knowledge and expertise in anesthesia techniques, monitoring patient vitals, and collaboration with the anesthesia team.
1
General anesthesia
2
Regional anesthesia
3
Local anesthesia
4
Monitored anesthesia care
5
Combined anesthesia
Perform skin disinfection
Thoroughly clean and disinfect the surgical site on the scalp to reduce the risk of infections during the Extracranial-Intracranial Bypass Procedure. Proper skin disinfection is essential for maintaining the sterility of the surgical field and preventing potential post-operative complications. The desired result is a sterile and disinfected surgical site. It requires adherence to proper aseptic techniques, effective use of antiseptic solutions, and collaboration with the surgical team to ensure adequate exposure of the surgical site.
1
Chlorhexidine
2
Povidone-iodine
3
Hydrogen peroxide
4
Alcohol-based solution
5
Iodine solution
Approval: Neurosurgeon to proceed with surgery
Will be submitted for approval:
Complete comprehensive pre-operative assessment
Will be submitted
Ensure consent has been obtained
Will be submitted
Perform patient positioning
Will be submitted
Initiate anesthesia administration
Will be submitted
Perform skin disinfection
Will be submitted
Make incision in scalp
Perform a precise and controlled incision on the scalp at the predetermined site to access the skull and underlying brain structures during the Extracranial-Intracranial Bypass Procedure. The incision plays a critical role in providing access and exposure necessary for the subsequent steps of the surgery. The desired result is a well-placed incision that allows optimal visualization and access to the surgical area. It requires surgical skills, knowledge of anatomical landmarks, and coordination with the surgical team.
1
Linear incision
2
Curvilinear incision
3
Z-shaped incision
4
Hockey-stick incision
5
Elliptical incision
Elevate specified areas of the skull
Gently separate and lift specific areas of the skull, using specialized surgical instruments, to gain access to the underlying brain structures and create adequate space for the Extracranial-Intracranial Bypass Procedure. Properly elevating the skull helps in creating a well-prepared surgical field, minimizing trauma to the surrounding tissues, and optimizing visibility. The desired result is an effectively elevated skull that allows safe and efficient access to the surgical site. It requires surgical skills, knowledge of skull anatomy, and careful tissue handling to minimize potential complications.
1
Frontal bone
2
Temporal bone
3
Parietal bone
4
Occipital bone
5
Sphenoid bone
Prepare graft vessel
Prepare the graft vessel, which will be used to establish a bypass for blood flow, during the Extracranial-Intracranial Bypass Procedure. The graft vessel may be harvested from a different part of the patient's body, such as the leg or arm, or from a suitable donor. Proper preparation ensures graft viability, optimal size, and adequate length for the bypass. The desired result is a properly prepared graft vessel that can be securely connected to the recipient vessels. It requires surgical skills, knowledge of vascular anatomy, and proper handling and storage techniques for the graft vessel.
1
Autograft - Leg
2
Autograft - Arm
3
Allograft
4
Synthetic graft
5
Biosynthetic graft
Initiate brain blood flow measurement
Start monitoring and measuring the blood flow within the brain to assess the effectiveness of the Extracranial-Intracranial Bypass Procedure. Measuring brain blood flow provides crucial information about the success of the bypass and the restoration of blood supply to the target area. The desired result is accurate and continuous monitoring of brain blood flow during the procedure. It requires specialized monitoring equipment, knowledge of cerebral perfusion techniques, and collaboration with the surgical team.
1
Transcranial Doppler
2
Intraoperative angiography
3
Laser Doppler Flowmetry
4
Indocyanine Green Angiography
5
Electromagnetic flowmetry
Connect graft vessel to recipient vessel
Securely connect the prepared graft vessel to the recipient vessel, creating the bypass for blood flow, during the Extracranial-Intracranial Bypass Procedure. Skillful connection of the graft and recipient vessels ensures proper blood flow and avoids complications such as leakage or thrombosis. The desired result is a successfully established bypass with adequate blood flow through the connected vessels. It requires surgical skills, knowledge of microvascular techniques, and careful suturing and anastomosis.
1
Superficial temporal artery
2
Middle cerebral artery
3
Anterior cerebral artery
4
Posterior cerebral artery
5
Internal carotid artery
Verify successful blood flow through new setup
Confirm the proper functioning of the newly established bypass and validate the blood flow through the connected vessels during the Extracranial-Intracranial Bypass Procedure. Verification ensures that the bypass is working as intended, restoring blood supply to the target area. The desired result is a confirmed and sufficient blood flow through the bypass and connected vessels. It requires careful observation, real-time monitoring of blood flow, and collaboration with the surgical team.
1
Pulsatile flow
2
Color change
3
Improved patient condition
4
Positive intraoperative angiography
5
Stable cerebral perfusion pressure
Approval: Neurosurgeon to close surgical site
Will be submitted for approval:
Verify successful blood flow through new setup
Will be submitted
Place sutures to close the incision
Carefully close the incision on the scalp using sutures to promote optimal healing and reduce the risk of complications after the Extracranial-Intracranial Bypass Procedure. Proper wound closure is crucial for achieving a cosmetically acceptable outcome and minimizing the chance of infection or wound dehiscence. The desired result is a secure and well-approximated incision. It requires surgical skills, knowledge of wound closure techniques, and attention to detail in achieving an optimal cosmetic outcome.
1
Interrupted sutures
2
Continuous sutures
3
Subcuticular sutures
4
Staples
5
Surgical adhesive
Complete post-operative sterilization
Thoroughly clean and sterilize the surgical field and surrounding areas after the completion of the Extracranial-Intracranial Bypass Procedure. Post-operative sterilization helps in reducing the risk of surgical site infections and promoting proper wound healing. The desired result is a sterile and clean environment. It requires adherence to aseptic techniques, effective use of sterile solutions, and collaboration with the surgical team to ensure a comprehensive sterilization process.
1
Sterile saline irrigation
2
Ethylene oxide sterilization
3
Autoclave sterilization
4
Ultraviolet light sterilization
5
Chemical disinfection
Monitor patient recovery
Closely observe and monitor the patient's vital signs, neurological status, and overall recovery progress after the Extracranial-Intracranial Bypass Procedure. Continuous monitoring and assessment are crucial in detecting any post-operative complications and ensuring appropriate post-operative care. The desired result is a stable and gradually improving patient condition post-surgery. It requires knowledge of post-operative monitoring protocols, effective communication with the healthcare team, and prompt action in response to any concerning signs or symptoms.
1
Blood pressure
2
Heart rate
3
Respiratory rate
4
Oxygen saturation
5
Neurological deficits
Discuss surgery results with family members
Initiate a conversation with the patient's family members to discuss the results and outcomes of the Extracranial-Intracranial Bypass Procedure. Open and clear communication with the family can provide reassurance, address any concerns or questions, and involve them in the post-operative care plan. The desired result is a well-informed and supported family who understands the surgery outcomes and the next steps. It requires effective communication skills, empathy, and appropriate medical knowledge to explain the surgical results in understandable terms.
Approval: Discharge from hospital
Will be submitted for approval:
Monitor patient recovery
Will be submitted
Discuss surgery results with family members
Will be submitted
Arrange follow up appointments
Schedule and coordinate follow-up appointments for the patient to ensure appropriate post-operative care and monitoring after the Extracranial-Intracranial Bypass Procedure. Follow-up appointments allow healthcare professionals to assess the patient's recovery progress, address any concerns or complications, and provide necessary guidance for long-term management. The desired result is a well-organized and timely follow-up plan. It requires effective scheduling and coordination skills, consideration of patient availability, and collaboration with the healthcare team.
Compile a detailed surgery report
Create a comprehensive and detailed report summarizing the Extracranial-Intracranial Bypass Procedure, including surgical steps, findings, outcomes, and recommendations. The surgery report serves as an essential document for future reference, communication with other medical professionals, and potential research or quality improvement initiatives. The desired result is a well-structured and informative surgery report. It requires accurate documentation, concise and clear language, and reviewing the report for completeness and accuracy.
