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Craniotomy

Definition

A craniotomy is a surgical procedure to open the skull. A part of the skull, called a bone flap, is removed to gain access to the brain for other procedures. In most cases, the bone flap is replaced after the procedure is finished. Craniotomies vary in size depending on what the problem is.
A craniotomy is any surgical opening into the skull, but it can also be named for the type of procedure that needs to be done, or how it is carried out. Other craniotomies types may include:
  • Burr hole or keyhole—a small, dime-sized hole is made in the bone of the skull
  • Awake—once the bone in the skull is opened, you are awakened from anesthesia
  • Stereotactic—computer navigation is used take images of the problem area, which then guide the surgeon to the precise location in the brain through one or more burr holes
  • Endoscopic—a lighted scope with a camera is inserted into the brain through one or more burr holes
Craniotomy
IMAGE
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

The type of procedure depends on the reason it is being done. The most common reasons for a craniotomy include:
  • Biopsy
  • Brain cancer
  • Head trauma
  • Blood clot in the brain
  • Blood vessel problems with the brain
  • Nerve disorders
  • Brain swelling
  • Brain infection
  • Hydrocephalus treatment—insertion of a ventriculoperitoneal shunt which allows excess cerebrospinal fluid to drain into another area, usually the abdomen
Smoking may increase the risk of complications.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Bleeding
  • Infection
  • Brain swelling
  • Damage to your brain which may cause:
    • Changes in memory, behavior, thinking, or speech
    • Vision problems
    • Problems with balance
    • Bowel and bladder problems
    • Seizures
    • Paralysis or weakness
  • Reaction to anesthesia
  • Heart attack
  • Blood clots

What to Expect

Prior to Procedure

Your doctor may do the following before your procedure:
Before surgery, you will need to:
  • Arrange for a ride home.
  • Arrange for help at home while you recover.
  • Talk to your doctor about any medications, herbs, or supplements you are taking. You may need to stop taking some medications up to 1 week before the procedure.
Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

Anesthesia

  • General anesthesia —Used for most craniotomies. You will be asleep during the surgery.
  • Local anethesia—Used for stereotactic craniotomies. This blocks around the surgical site from pain, but you will still be awake.
General anesthesia is used to start awake craniotomies. Once the brain is exposed, the effects of anesthesia are slowly reversed. This is done so you can interact with the surgeons during the procedure. This helps them map the brain and determine which parts of the brain are critical for functioning.

Description of Procedure

Your head will be shaved and your skin will be washed with an antiseptic. An incision will be made into part of your scalp. Next, part of your skull will be removed and your brain covering will be opened. Depending on the reason for your surgery, several things may happen: a tumor may be removed, a part of your brain tissue may be taken, a tube may be placed, or repairs to your brain or its vessels may be done. The brain opening will then be sewn back into place and your skull replaced. Staples or stitches will be used to close the incision. A drain may be inserted to remove blood and fluid for the first few days after surgery. A dressing will be wrapped around your head.

How Long Will It Take?

Several hours, depending on the type and reason for surgery

How Much Will It Hurt?

Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.

Average Hospital Stay

The usual length of stay is 3-7 days. It is possible that you may have to stay longer if complications arise.

Post-procedure Care

At the Hospital
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, breathing, and mental status will be monitored.
You may be given medications to prevent:
  • Pain
  • Infection
  • Blood clots
  • Seizures
The staff will take measures to prevent pressure build-up in your brain.
You will be asked to get out of bed and walk around to prevent complications like blood clots or pneumonia .
At Home
When you return home, take these steps:
  • Continue with your physical therapist’s exercise program.
  • Be sure to follow your doctor's instructions.
If you feel symptoms of depression for more than two weeks, consider talking to a therapist or psychologist.

Call Your Doctor

Call your doctor if any of these occur:
  • Any changes in physical ability, including balance, strength, or movement
  • Any changes in mental status, including level of alertness, memory, thinking, or ability to respond
  • Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision
  • Headache that does not go away
  • Stiff neck
  • Changes in vision, including double, blurred, or vision loss
  • Fainting or seizures
  • Numbness, tingling, or weakness in your face, arms, or legs
  • Signs of infection, including fever and chills
  • Persistent nausea or vomiting
  • Pain that you can't control with the medications you've been given
  • Difficulty breathing
  • Cough , shortness of breath, or chest pain
  • Trouble controlling your bladder and/or bowels
  • Swelling, tenderness, hotness, or redness anywhere in your legs
If you think you have an emergency, call for emergency medical services right away.

RESOURCES

American Brain Tumor Association http://www.abta.org

National Brain Tumor Society http://www.braintumor.org

CANADIAN RESOURCES

Brain Tumor Foundation of Canada http://www.braintumour.ca

Canadian Cancer Society http://www.cancer.ca

References

Awake craniotomy treatment. University of Miami Health System website. Available at: http://neurosurgery.med.miami.edu/clinical-subspecialties/brain-tumors/awake-craniotomy-treatment1. Accessed December 5, 2014.

Brain tumor information. National Brain Tumor Society website. Available at: http://www.braintumor.org/brain-tumor-information. Accessed December 5, 2014.

Guide to the care of the patient with craniotomy post-brain tumor resection. American Association of Neurological Nurses website. Available at: http://www.aann.org/pdf/cpg/aanncraniotomy.pdf. Accessed December 5, 2014.

Hydrocephalus in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 25, 2014. Accessed December 5, 2014.

What is a craniotomy? Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/neurology%5Fneurosurgery/specialty%5Fareas/brain%5Ftumor/treatment/surgery/craniotomy.html. Accessed December 5, 2014.

6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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