Craniotomy

Overview

A craniotomy is a significant surgical procedure involving the removal of a portion of the skull, known as a bone flap, to gain access to the brain. Specialized tools are employed to extract the bone flap, allowing neurosurgeons to perform various brain surgeries. Following the necessary intervention, the removed section of the skull is carefully replaced. Typically undertaken in response to conditions such as brain tumors, life-threatening illnesses, or traumatic brain injuries, a craniotomy is a major surgical undertaking that neurosurgeons consider after thorough diagnosis.

Types of craniotomy

There are various types of craniotomy procedures, each named based on the specific location where the surgeon removes a portion of the skull to access the brain:

• Frontal: Involves the front portion of the skull near the hairline.
• Temporal: Focuses on the section of the skull adjacent to the eyes and in front of the ear.
• Parietal: Targets the top-middle and upper back regions of the skull.
• Pterional (frontotemporal): Concentrates on the side of the skull behind the temple.
• Orbitozygomatic: Addresses the part of the skull near the eye socket and cheek.
• Retrosigmoid (keyhole): Utilizes a small incision in the skull area behind the ear.
• Suboccipital: Involves the base of the skull, situated above the neck.

Reasons for undergoing the procedure

A craniotomy might be required to treat:

• Vascular malformations, or an abnormal collection of blood vessels.
• Arteriovenous malformation or intertwined blood vessels.
• Aneurysm (enlarged artery)
• Bleeding in the skull
• Dura mater tear
• Abscess in the brain
• Brain pressure
• Swollen brain
• Seizure
• Fractured skull
• Tumors
• Blood clots

Risks

Potential risks and complications associated with a craniotomy encompass various factors, including but not limited to:

• Seizures.
• Stroke.
• Headaches.
• Coma.
• Pain.
• Hydrocephalus.
• Hematoma.
• Bleeding.
• Infection.

Certain types of craniotomies carry the possibility of being life-threatening. Your surgeon will provide a detailed explanation of these risks and collaborate with your healthcare team to proactively address and minimize any complications during and after the surgical procedure.

Before the procedure

Before undergoing a craniotomy, thorough planning by your surgeon is crucial. This involves a range of tests, including a physical examination, blood tests, and imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT) scan, positron emission tomography (PET) scan, or angiography. These tests help assess your health and determine the purpose of the surgery, while also assisting the anesthesiologist in determining the appropriate anesthetic dosage.

Your surgeon will provide specific preparation instructions, including arriving on an empty stomach on the day of surgery, discontinuing blood-thinning medications, and possibly taking antibiotics, anticonvulsants, or corticosteroids. During a pre-surgery consultation, your surgeon will discuss test results, explain the procedure, outline potential side effects, inform you about healing times, and address any questions you may have about the upcoming surgery.

During the procedure

On the day of a craniotomy surgery, the process begins with the administration of anesthesia by an anesthesiologist to ensure the patient doesn’t feel any pain. In the operating room, meticulous positioning of the head and body is carried out to avoid exerting pressure on specific points. The surgeon initiates the procedure by shaving hair near the incision site, followed by the sterilization of the head to minimize infection risks. Subsequently, an incision is made, its location dependent on the specific type of craniotomy needed. The surgeon then adjusts the skull muscles, drills holes, and uses a medical saw to cut between them, extracting a piece of the skull. This removed portion is temporarily placed on a surgical instrument table for later use in closing up the skull.

The subsequent phase involves addressing the brain condition, where the surgeon either removes or repairs the affected area. In certain cases, particularly when the surgery involves regions controlling movement, speech, or vision, the patient may need to be awake for what is known as an “awake” craniotomy. Localized anesthetic is administered to eliminate pain without inducing sleep. The duration of craniotomy procedures typically ranges from three to five hours, though variations may occur based on the complexity of the surgical requirements. Once the brain treatment is completed, the surgeon carefully repositions the skull piece, akin to assembling a puzzle, and restores muscles and tissues to their original places before closing the skin incision.

After the procedure

Following a craniotomy, patients transition to the intensive care unit (ICU) for close monitoring until they are stable enough to leave. The postoperative period, typically lasting up to a week, involves staying in bed with the head elevated, constant vital sign monitoring, and administration of necessary medications for comfort and complication prevention. Once ready for discharge, patients receive comprehensive instructions for continued recovery at home, with a primary emphasis on rest and recuperation.

Outcome

After a craniotomy, the average recovery time is six to eight weeks, with approximately one week spent in the hospital post-surgery. Your healthcare team will provide guidance on when you can resume normal activities, considering factors such as your overall health and the extent of the surgery. Avoid physically demanding activities until cleared by your healthcare provider. Discuss surgery risks with your surgeon beforehand.

Contact your healthcare provider if you observe issues like slow healing, severe pain, swelling, or fever. In case of an emergency, call your local emergency services number for signs of stroke, difficulty breathing, or seizures.