A craniotomy is a surgery used to provide neurosurgeons direct access to the brain. The procedure involves removing part of the skull called a bone flap. A craniotomy can be used to remove tumors, clip aneurysms, drain brain infections or treat traumatic brain injuries (TBIs), as well as implant devices such as shunts and deep brain stimulators. The surgeon is often guided by magnetic resonance imaging (MRI) or computed tomography (CT) scans, in which case the surgery is called stereotactic craniotomy.
Craniotomies are used to access the brain as part of a larger treatment. Conditions that often require a craniotomy for treatment include:
Craniotomies are also used to give surgeons access to the brain during stereotactic biopsies of brain tumors.
Most craniotomies are performed under general anesthesia, meaning that the patient is asleep. The patient’s head will be affixed by a frame to keep it still. The surgeon will first make an incision in the scalp and pull back the skin. Next, the skin and muscles are moved away and small holes called burr holes are drilled into the skull. Then, surgeons use a saw called a craniotome to cut and remove the bone flap, exposing the dura—the brain’s protective covering. The dura is then opened, exposing the brain.
Surgeons now have access to the brain and can proceed with treatment. When the procedure is over, the bone flap is replaced.
Craniotomies are classified by what section of the skull is removed during the procedure. Some types are minimally invasive, and almost all craniotomies are stereotactically assisted.
Burr hole—Also known as trepanation, this is the least invasive craniotomy, requiring the smallest bone flap. Burr holes are often classified separately from craniotomies. These holes are often used to alleviate pressure on the brain from fluid.
Extended bifrontal craniotomy—This type of craniotomy opens the front of the skull—the forehead. It is often used to perform surgery to remove meningiomas.
Orbitozygomatic craniotomy—This type of craniotomy removes a relatively large section of the skull from above the cheek. It is used for larger tumors that surgeons cannot access with a less invasive technique.
Supraorbital craniotomy—Also known as an eyebrow craniotomy, this minimally invasive surgery can be used to remove pituitary tumors. It provides access to the front of the brain, with incisions made in the eyebrows.
Translabyrinthine craniotomy —A translabyrinthine craniotomy removes the mastoid bone and part of the inner ear. It is used to treat acoustic neuromas when either the patient is deaf or hearing must be sacrificed to remove the tumor.
Craniectomy vs. craniotomy—A craniectomy is a similar procedure to a craniotomy, but there is one crucial difference: the bone flap is not replaced in a craniectomy. This is often due to swelling of the brain or to an infection around the bone flap.
Before the surgery, your surgical team will need to know some information, such as:
You will likely need to fast for a short period before the surgery so you don’t get sick from anesthesia. You will also undergo a preoperative neurological exam, to be compared to a postoperative exam. Before surgery, the area of your scalp that the surgeon is to cut will be shaved.
A craniotomy usually requires a hospital stay of about three days to a week, but you may have to stay much longer depending upon the full procedure. Immediately after the surgery you will probably be taken to the intensive care unit to recover. You may need supplemental oxygen for a short period. There may be significant swelling, which can be managed through elevation of the head and through medication.
You will be encouraged to move around as soon as it is comfortable for you to do so. This will help prevent blood clots in your legs from being inactive for too long. Compression devices on your legs can further cut the risk of blood clots.
Once you are discharged from the hospital, it is important to keep the incision clean and dry. Your surgeon will provide specific wound care instruction. The incision should heal in approximately three to four weeks. You should gradually ramp up your physical activity in the coming weeks. You may be instructed to avoid heavy lifting for a period of weeks.
Infections such as meningitis and others are a risk after brain surgery. Be on the lookout for the following symptoms:
At Neurosurgical Associates of Central Jersey, our experienced surgeons are experts in brain surgery procedures such as craniotomies. We employ the only the latest cutting-edge tools and techniques available. If you have a condition that may require a craniotomy, contact us today to discuss your options.