Craniotomy Surgery in Delhi, India
Overview
A craniotomy is a procedure in which a segment of the skull bone is removed to access the brain. After the surgery, this segment is replaced with either a bone graft or a bone flap.
This surgery is performed to remove aneurysms and brain tumours or to excise brain tumours surgically. In addition, in cases of trauma or injury, there are chances of swelling developing intracranially; to prevent that, a craniotomy may be performed. The surgery is performed by an experienced neurosurgeon.
In some cases, the patient is kept awake to monitor brain function, while in others, they are sedated. For instance, if the surgery is to be performed in areas of the brain that controls movement, vision or speech, patients are kept awake to monitor brain function. This ensures that the surgeon is treating the right area of the brain. In addition, it lowers the risk of developing speech, movement or vision impairment.
Types of Craniotomy
Craniotomies are of different types, named after the technique or location of the surgery, as follows:
- Stereotactic craniotomy
- Endoscopic craniotomy
- Awake craniotomy
- Key-hole craniotomy
- Supraorbital eyebrow craniotomy
- Pterional (frontotemporal) craniotomy
- Orbitozygomatic craniotomy
- Translabyrinthine craniotomy
- Posterior fossa craniotomy
- Bifrontal craniotomy
When is Craniotomy Surgery Needed
A craniotomy is indicated in cases where the individual is at risk of developing swelling in the cranial cavity or a tumour has been diagnosed and needs to be surgically removed.
A craniotomy is performed for the treatment of the following conditions of the brain:
- Tumours
- Infection
- Brain abscess
- Skull fracture
- Aneurysm
- Dura mater tear
- Swelling (cerebral oedema)
- Bleeding inside the skull
- Blood clot
- Arteriovenous malformation
- Intracranial pressure
- Arteriovenous fistula
- Epilepsy
In addition, this procedure is used to implant medical devices in the brain to allow movement in people with movement disorders such as Parkinson's disease.
Who Should Not Consider Craniotomy Surgery
A craniotomy is not the ideal choice of treatment for patients with advanced age, poor overall health, or severe cardiopulmonary disease.
How to Prepare for Craniotomy Surgery
- First, the patient is assessed, and doctors determine the kind of anaesthesia that is required to administer. This means considering whether the patient needs to be sedated or kept awake during the surgery.
- To prepare for the surgery, an appointment with the surgeon is scheduled, at which consent is obtained, and any questions regarding the surgery are addressed.
- In addition, they record the patient's personal and family medical history.
- They also prescribe certain tests to confirm that the patient is the right case for craniotomy; these include:
- Physical exam
- Blood tests
- Neurological exam
- Imaging tests of the brain, such as CT or MRI scans
- These tests help doctors locate the site of the operation, evaluate the medical condition of the patient and then plan the type of surgery and its procedure accordingly.
Some common instructions that should be followed before surgery include the following:
- On the night before surgery, follow fasting for at least 8-12 hours. This helps prevent the side effects of anaesthesia.
- Wash hair with antiseptic shampoo.
- Inform the doctor of all medications being taken.
- Inform them about any existing allergies or medical ailments.
Craniotomy Surgery Procedure
- An anaesthesia specialist administers anaesthetic medicine to prevent any pain or discomfort during surgery. In addition, they also monitor the patient's vital signs during the surgery.
- After numbing, incisions are made after trimming some hair to access and visualise the surgical site.
- The patient's head is fixated, and once the surgery is completed, sutures are placed, and a sterile bandage is put in place.
- Surgeons use brain mapping and 3-D computer images to excise tumours or epileptic focus without damaging normal tissues.
- During surgery, a neurosurgeon or a speech-language pathologist might keep asking questions to evaluate the brain function of speech, eyesight, and neuro-muscular coordination.
- The procedure can take about two to two and a half hours.
Craniotomy Surgery Complications
As with any brain surgery, craniotomy also carries potential risks and complications. These include:
- Bleeding
- Brain swelling
- Infection
- Brain damage or death
- Seizures
- Muscle weakness
- Problems with memory and thinking
- Head scarring
- Formation of a dent where the bone flap was removed
- Injury from the head device
- Facial nerve damage
- Damage to the sinuses
- Leaking of cerebrospinal fluid
- Stroke
- Unstable blood pressure
- Pneumonia
- Allergic reaction to general anaesthesia
Rare complications of craniotomy surgery
- Speech problems
- Memory issues
- Balance issues
- Paralysis
- Coma
Craniotomy Surgery Risks
Like every surgical procedure, craniotomy carries some risks. These include:
- Changes in your vision
- Seizures
- Swelling of the brain or excessive fluid in the brain
- Meningitis
- Leaking spinal fluid
- Difficulty with speech or learning
- Loss of memory
- Impaired coordination and balance
- Stroke
- Weak muscles
Care After Craniotomy Surgery
- After the surgical procedure is completed, the patient is shifted to the recovery room to monitor their vital signs. Once stable, they are moved to ICU.
- After the surgery, an MRI is taken to evaluate the success of the surgery. Patients are often required to stay at the hospital for about 2-3 days.
- Patients can resume routine activities in 6 weeks to 3 months. It is essential to follow up with the doctor regularly after recovery.
Craniotomy Surgery Outcomes
- Individuals who have undergone craniotomy to treat epilepsy experience significant improvements in the frequency of seizure episodes. Some people may never have an episode again, while others may experience a reduced frequency. Seldom no change in the frequency of occurrence of seizures may be seen.
- If the surgery was carried out to remove a tumour through awake brain surgery, the surgeons are often able to excise the tumour entirely. However, additional treatments such as radiation or chemotherapy may be needed to destroy any remaining tumour tissue.
The care during the recovery period depends on the type of surgery. This includes:
Immediately after surgery
- Vital signs are monitored, and after recovery in the ICU, patients are shifted to the standard room for further care.
- A week's stay at the hospital can be expected.
During the stay, doctors will likely:
- Keep the head elevated to prevent swelling
- Keep the patient on oxygen for several days
- Teach deep-breathing exercises to prevent the development of pneumonia
- Place compression devices on the legs to prevent blood clots
- Frequent neurological checkups are carried out to ensure that the brain and body are functioning properly.
At home
- Follow the doctor's instructions as given.
- Take medications as prescribed. Some people find it difficult to walk and talk, might feel weak, and be off-balance.
- Physiotherapy, speech therapy, or occupational therapy will help regain function.
- It is essential to get adequate rest and visit the doctor for regular follow-up visits.
Reviewed & Updated On
Reviewed by Dr. Anil Dhar, Senior Consultant and Unit Head Neurosurgery, Neurosciences, Spine Surgery on 28-Mar-2023.