Craniectomy

Overview

A major brain surgery known as a craniectomy involves the removal of a portion of the skull to allow the surgeon to access the brain. During this treatment, your surgeon does not replace your skull. The portion of your skull that was removed is replaced at a later date with a follow-up procedure termed a cranioplasty.

Your doctor may decide to perform a craniectomy in order to relieve pressure, swelling, or hemorrhaging (excess fluid) on your brain. There is little space between your brain and your skull, so pressure from swelling or excess fluid inside your skull can be fatal or harm your brain. Any kind of pressure is harmful and has the potential to alter brain function.

A decompression craniectomy is the term your surgeon may use for a craniectomy.

Reasons for undergoing the procedure

Craniectomy is indicated for the following conditions:

• Bleeding (hemorrhage) or extra fluid
• Pressure (intracranial pressure or hypertension)
• Swelling

The following are some possible causes of cerebral edema, pressure, or hemorrhage (excess fluid):

• Stroke
• Trauma
• Hematoma
• Blood clot

Risks

Among the risks connected to craniectomy are:

• Infection
• Bleeding
• Seizure
• Hernia
• Damage to the brain
• Paralysis
• Inability to speak
• Behavioral or mood alterations
• Coma

These issues may prove to be lethal. After surgery, you may have a higher risk of falling and losing your balance and coordination, so it’s critical that you receive the rest you require until you’re well enough to walk or move independently. Following a craniectomy, your surgeon will explain what to anticipate and when you can resume your normal range of motion.

Before the procedure

Typically, a craniectomy is an emergency surgical procedure. It’s unlikely that you will have time to be ready for this surgery.

Prior to your procedure, the following will be required by your surgeon and the medical team:

• Physical assessment
• Blood tests
• Diagnostic imaging tests: X-ray, Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scan, Positron Emission Tomography (PET) scan or angiography

Your surgeon will advise you whether to cease taking any drugs, particularly blood thinners, prior to surgery if it is not an emergency. You may be advised to take antibiotics or anticonvulsants by your surgeon. A meal shouldn’t be consumed before the procedure.

During the procedure

An anesthesiologist will administer anesthetic to you before to your procedure in order to prevent pain. Certain craniectomy surgeries require general anesthesia, while others may involve keeping you awake so that your surgeon can assess your cognitive abilities during the procedure.

When your surgeon arrives in the operating room, they will:

• Trim your hair close to the incision site and clean the affected area of your head.
• Make a cut or incision on your skin. They will reposition muscles and tissues to expose your scalp.
• Drill holes in your skull, then make incisions between each hole to remove a part of your skull.
• Address the cause for the craniectomy.
• Use a mesh material to cover the exposed portion of your skull.
• Use sutures or staples to seal the skin incision after realigning the muscles and skin tissue beneath it.

Typically, a craniectomy requires three to five hours to perform. The reason for needing a craniectomy determines how long some operations take.

After the procedure

You will be sent to an Intensive Care Unit (ICU) following a craniectomy. Your doctor will keep an eye on your vital signs as well as any brain swelling or bleeding. You will need to wear a helmet to protect your brain from injury since your surgeon will not replace the portion of your skull that was taken during surgery.

The portion of your skull that was removed will be saved by your surgeon for use in a subsequent procedure known as a cranioplasty. Alternatively, a metal plate or a synthetic material may be used by the surgeon to replace the missing portion of your skull.

Following a craniectomy, you will require a lot of rest. When you’re relaxing, tilt your head up rather than down. Throughout your hospital stay, your doctor will assist you, provide instructions, and get you ready to return home when the time is right. Following your surgery, you’ll need to schedule follow-up sessions to make sure your recuperation is going as planned.

Outcome

The reason and degree of the surgery will determine how long it takes you to recuperate after a craniectomy. Your skull will mend in a month or two on average, but recovery could take years. When you have a second surgery (crainioplasty) to replace the part of your skull that was removed, your recovery will take longer. After a craniectomy, prolonged rehabilitation and ongoing care are frequently required.