What is a craniotomy?

A craniotomy is the surgical procedure to temporarily remove part of the skull to access the brain. During the procedure, your neurosurgeon will remove a section of bone, perform the surgery and then replace the skull when he or she is finished.

Types of craniotomy 

Depending on the location of the skull opening, your craniotomy may be called:

  • Frontal craniotomy - a craniotomy in the front area of the skull 
  • Parietal craniotomy - a craniotomy in the mid to posterior hemisphere of the skull
  • Temporal craniotomy - a craniotomy in the area in front of the ear and beside the eyes
  • Occipital craniotomy - a craniotomy in the base of the skull
  • Suboccipital craniotomy - a craniotomy that accesses the brain from behind the ear

To minimize complications, your doctor will make the skull opening as small as possible. A minimally invasive craniotomy that is performed in a small opening approximately the size of a quarter is called a keyhole craniotomy. A craniotomy with an opening about the size of a dime is called a burr hole craniotomy.

When is a craniotomy necessary?

Your doctor may recommend a craniotomy if you have any of the following conditions:

  • Brain tumor 
  • Aneurysm
  • Skull fractures 
  • Brain swelling 
  • Infection in the brain 
  • Brain abscess
  • Arteriovenous malformation (AVM) - an abnormal mass of blood vessels
  • Tear in the brain’s membrane lining
  • Epilepsy
  • Parkinson’s disease or dystonia

Risks of a craniotomy

Complications associated with a craniotomy vary based on the area of the brain that the surgery affects. For example, if your surgeon is operating on an area that affects memory, your memory may be affected. 

The most common general complications include:

  • Infection at the surgery site
  • Severe bleeding
  • Blood clots that could lead to more severe side effects such as a brain aneurysm
  • Pneumonia
  • Swelling in the brain
  • Seizures
  • Unstable blood pressure
  • Leaking cerebrospinal fluid (fluid that cushions the brain)

What to expect during a craniotomy?

A craniotomy is a complex procedure that will take five hours or more to perform. 

Steps of the process include:

  • You will be given a general anesthesia so that you do not feel any pain during the procedure.
  • Your surgeon will make an incision in the scalp to see the skull.
  • Once in position, your surgeon will remove a piece of skull called a bone flap.
  • Your neurosurgeon will then cut through the outermost membrane lining of the brain.
  • When the surgeon has reached the affected area of the brain, he or she will work to correct the issue.
  • After the brain surgery is complete, your surgical team will stitch the incision, replace the bone flap and secure it using plates and screws.
  • Over time, the bone will heal together.

Recovery from a craniotomy

You will likely stay in the hospital for a week after a craniotomy. At discharge, your doctor will provide detailed discharge instructions. Follow these instructions closely to ensure a full recovery. Discharge instructions will include:

  • Pain relief -  If you are in pain, your doctor may prescribe pain medications that can help relieve pain and prevent complications such as brain swelling or seizure.
  • How to care for your wound - The incision takes as long as four weeks to heal, so you should keep it dry and clean.
  • When you can resume exercise - You can move around the day of surgery but will need to gradually return to your normal exercise routine.
  • Follow-up care - You should schedule follow-up appointments with your neurosurgeon and other specialists depending on what you were treated for.
  • Other follow-up care needed - You may need rehabilitation or physical therapy depending on the condition you were treated for.

Call your doctor right away if you experience any of the following symptoms after surgery:

  • Fever 
  • Changes in vision
  • Bleeding or drainage from the incision site
  • Confusion 
  • Extreme fatigue
  • Speech troubles
  • Seizures 
  • Trouble breathing or chest pain 
  • Weakness in your arms or legs

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