A craniotomy is the temporary removal of a small portion of skull bone. A neurosurgeon may perform a craniotomy to obtain access to the brain in order to treat any one of a number of conditions. At the conclusion of whatever procedure is necessary, the skull bone is replaced. (Craniotomy should not be confused with craniectomy, after which the bone is not replaced.)
In discussing a particular craniotomy, physicians may provide more specific information by adding terms that indicate the location on the skull, the size of the opening, and which technology and techniques are used.
Frontal, parietal, temporal, occipital and suboccipital describe a few of the regions of the skull. Therefore, sometimes these words precede craniotomy to indicate where an opening is made. For example, frontal craniotomy indicates the opening is made in the frontal region of the skull.
Our neurosurgeons make openings in the skull that are as small as possible. The required size of the hole varies depending on what the neurosurgeon will have to do once inside the skull. A craniotomy for surgery that will be performed through a small opening with minimally invasive techniques is referred to as a keyhole craniotomy. The smallest craniotomy, in which the opening is about the size of a dime, is called a burr hole craniotomy.
Technology and technique
Our neurosurgeons use the most sophisticated surgical techniques and technology when performing craniotomies. When an endoscope is used, as is often the case for keyhole craniotomies, the procedure may be referred to as endoscopic craniotomy. Similarly, when stereotactic techniques are used, the procedure may be called stereotactic craniotomy. A craniotomy performed to fenestrate a cyst is called a craniotomy fenestration.
Our neurosurgeons sit down with each patient to explain what kind of craniotomy will be performed in each case and to answer any questions.
Craniotomy can be performed to treat several brain abnormalities, including—but not limited to—brain tumor, aneurysm, arteriovenous malformation, brain abscess, hematoma, trigeminal neuralgia, hydrocephalus and epilepsy. Also, the procedure can be used as part of a procedure to biopsy abnormal tissue or to implant medical devices such as shunts, Ommaya reservoirs and subdural electrodes.
Craniotomy starts with general anesthesia; patients do not feel pain during the procedure. The neurosurgeon then makes an incision on the scalp and reflects the skin and muscle to reveal the skull. The location of the incision on the scalp, as well as the length of the incision, varies according to each patient’s needs. With the skull exposed, the neurosurgeon removes a small piece of skull bone, called the bone flap, and sets it aside. The bone flap will be replaced toward the conclusion of the operation.
Next, the neurosurgeon cuts through the dura mater using surgical scissors. Because the skull contains delicate brain tissue, blood vessels and nerves, and has little unoccupied space, the neurosurgeon uses an operating microscope and other advanced technology for extremely precise navigation. Stereotactic techniques, which employ computer technology and imaging studies to create three-dimensional images of the brain, are often helpful.
Having obtained access to the area in the brain that requires treatment, the neurosurgeon can then carry out the patient’s surgical plan.
To complete an operation performed via craniotomy, the neurosurgeon stitches up the incision in the dura mater and replaces the bone flap, securing it in place with titanium plates and screws. The bone will heal together over time, but the plates and screws do not need to be removed. Lastly, the neurosurgeon stitches up the incision on the scalp.
Be sure to inform your doctor of any medications or supplements—including vitamins, herbs or other natural substances—you are taking. Providing your doctor with this information is critical because certain medications or supplements (such as Warfarin and aspirin) can increase bleeding during surgery. Your doctor will be able to tell you whether anything you are taking falls in this category, in which case you may be instructed to suspend its use.
Also, tell your doctor if you are allergic to any medications or food.
Because general anesthesia is used during craniotomy, your doctor will request that you abstain from eating and drinking starting at midnight before the operation. If your doctor tells you to continue taking any medications on the day of the operation, take that medication with a small sip of water.
On the day of surgery, wear loose, comfortable clothing. Do not wear any jewelry, makeup or nail polish. Wear glasses instead of contact lenses.
For your hospital stay, which will likely be approximately one week, do your best to pack lightly. A few items that patients often like to bring include toiletries, dentures and a change of clothing to wear when they are discharged from the hospital.
After being discharged, you will not be allowed to drive yourself, so be sure to make arrangements for transportation home.
How long will I stay in the hospital?
Patients typically stay in the hospital for about one week.
Will I need to take any special medications?
Patients are usually prescribed medications for pain and to prevent potential complications such as seizure and brain swelling.
When can I resume exercise?
Patients are encouraged to move around every day if they have the energy but should consult with the neurosurgeon before resuming a regular exercise routine. Once the neurosurgeon has given approval, patients are advised to increase activity gradually and always to exercise with a partner or under supervision until fully recovered.
What follow-up will I receive?
Each patient will attend several follow-up appointments with the neurosurgeon and possibly also with another specialist—such as endocrinologist, neurologist, otolarynologist or ophthalmologist—depending on what condition was treated and whether any new symptoms arise after surgery.
During these follow-up appointments, the neurosurgeon will monitor the patient’s recovery progress. This may mean ordering imaging studies to visualize the brain or conducting other tests. Patients should describe any new or worsening symptoms.
It is essential for patients to attend all of these follow-up appointments in order to achieve the best possible recovery and long-term results.
Will I need rehabilitation or physical therapy?
The need for rehabilitation or physical therapy primarily depends on the condition treated. The craniotomy procedure itself typically does not result in a need for rehabilitation or physical therapy.
Will I have any long-term limitations due to craniotomy?
Possible long-term limitations depend largely on the condition treated. The craniotomy procedure itself typically does not cause long-term limitations.
Dr Richard Anderson (Pediatric), Dr. Jeffrey Bruce, Dr. E. Sander Connolly Jr., Dr. Neil Feldstein (Pediatric), Dr. Grace Mandigo, Dr. Guy McKhann, Dr. Marc Otten and Dr. Sameer Sheth are experts in craniotomy.
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