Craniotomy

A craniotomy is a surgical procedure in which a part of the skull, called a bone flap, is temporarily removed in order to access the brain for diagnostic or therapeutic purposes. The bone flap is usually stored nearby and later replaced and secured with plates, screws or wires.

The surgeon may then perform a variety of procedures, such as removing a brain tumour, clipping an aneurysm, or treating epilepsy. Once the procedure is complete, the bone flap is replaced and secured, and the scalp is closed with sutures or staples.

Alternate Name

Retro-sigmoid craniotom , Keyhole craniotomy

Body Location

Brain

Conditions That Require Craniotomy/b>

Several conditions may require your surgeon to get access to your brain. Though it may sound scary, craniotomy is a common procedure done to diagnose/correct/treat almost all brain conditions. Some common reasons to perform craniotomy are:

• Diagnosis and treatment of brain tumours - Brain tumours are an abnormal growth of cells in the brain. They may originate in the brain cells or lymphatic system and may interfere with the regular functioning of the brain.
• Aneurysms - Aneurysms are swollen blood vessels that may burst if not clipped
• Brain infections - Autoimmune, viral and bacterial infections may affect the brain and cause an inflammation
• Abscesses - Following a head injury, fluids build up and form sacs called abscesses
• Cerebral oedema - The swelling of the brain due to an injury or an infection is called cerebral oedema.
• Bleeding - Following an accident or a shock, blood vessels leak blood into the brain.
• Epilepsy - Epilepsy is a neurological disorder that may cause abnormal brain functioning causing seizures, unusual behavioural changes, loss of consciousness and abnormal sensations
• Implant devises to treat Parkinson's disease - A neurological disorder causing episodes of trembling

How is Craniotomy Performed?

Depending on the purpose of the craniotomy and the type of craniotomy opted for, the surgery time and preparation may differ. On average, it may take around three hours for the entire procedure.

• Fluids and medications are administered intravenously to prepare you for the surgery.
• A catheter (urinary tube) is inserted to drain the urine.
• Since it is an open procedure, the anesthesiologist administers general anaesthesia so that you do not feel the pain.
• The neurosurgeon then makes an incision on the skull depending on the place where the procedure needs to be done.
• The surgeon then performs the targeted procedure or collects samples for diagnosis.
• Once the procedure is done, the incised bone flap is sutured and closed with a bandage.

Depending on your medical condition, there are different kind of craniotomy preferred:

• Endoscopic Craniotomy – The neurosurgeons insert a scope fitted with a light source, camera, and surgical equipment to perform a procedure through a tiny cut or incision.
• Stereotactic Craniotomy – Craniotomy is accompanied by a CT scan or an MRI to assist the neurosurgeons to visualise internal structures of the brain. This way, it is easy to perform surgery or to make a diagnosis.
• Extended Bi-frontal Craniotomy – In this procedure, the bone that together forms the forehead is removed by making a small cut behind the hairline. Once the procedure is complete, the removed bone is replaced.
• Minimally Invasive Supra-Orbital Eyebrow Craniotomy – A small cut is made around the eyebrow to perform procedures on the frontal side of your brain. It is a minimally invasive procedure where the recovery is quick, pain is less and scarring is minimal.
• Retro-sigmoid Keyhole Craniotomy – In this process a small cut is made behind the patient's ear to perform procedures in the back of the brain.
• Orbitozygomatic Craniotomy – In this procedure, the bone present between the cheek and the orbit (eye socket) is removed to help neurosurgeons access the optic nerve and the area surrounding the eye. This procedure minimizes brain damage and provides access to many parts of the brain.

Preparation

Your surgeon and the medical team will communicate with you on how to prepare for craniotomy well before the procedure. Some of the common preparatory measures are:

• Chest X-rays, blood tests, ECG, CT, MRI, or PET brain scans are recommended before performing the procedure to know if you are physically ready for the procedure.
• You will be asked to avoid taking anti-inflammatory or blood-thinning medications for at least a week before the procedure.
• You may be prescribed medications to help with anxiety and avoid swelling, infection, or seizures following the procedure.
• You will be asked to refrain from smoking, alcohol, and chewing tobacco for at least a week or two before surgery.
• You will be asked to not drink or eat anything for eight to twelve hours before the procedure.
• The specific area of your head where the procedure is to be performed is shaved.

Procedure Type

A craniotomy can be both invasive and minimally invasive depending on the purpose.

Follow-up

You may feel slight pain for a few days following the procedure, but will be prescribed medication to alleviate the pain. Regular follow-up visits help prevent complications.

Risks and Complications of Craniotomy

Risks and complications are associated with any surgery. Sometimes, during a craniotomy, some complications associated with the area of the brain being operated upon may occur. Apart from this, some of the general complications that may occur during craniotomy are:

• Bleeding
• Infection
• Blood clot
• Fluctuations in blood pressure
• Pneumonia/infection of the lungs
• Seizures
• Swelling in the brain
• Cerebrospinal fluid (the fluid that surrounds the brain and acts like a shock absorber) leakage
• Reactions to general anaesthesia

Some rare complications associated with craniotomy are:

• Speech difficulty
• Memory impairment
• Paralysis
• Coma
• Changes in balance and coordination

Recovery

Recovery from craniotomy depends on your medical condition and the procedure performed. You may be asked to stay in the hospital for a few days and may be asked to refrain from vigorous activities for a few months after reaching home. It usually takes many weeks to months for you to resume your routine following the craniotomy. Speak with your doctor regarding the dos and don’ts following the procedure.