Craniotomy Surgery in Delhi, India

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

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.

A craniotomy is not the ideal choice of treatment for patients with advanced age, poor overall health, or severe cardiopulmonary disease.

• 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.

• 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.

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

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

• 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 by Dr. Anil Dhar, Senior Consultant and Unit Head Neurosurgery, Neurosciences, Spine Surgery on 28-Mar-2023.

What is a craniotomy, and why is it performed?

A craniotomy is a surgical procedure in which a portion of the skull is removed to access the brain. It is performed for various reasons like brain tumour removal, treatment of an aneurysm, or relief of pressure on the brain due to swelling or bleeding.

How long does it take to recover from a craniotomy?

Recovery time varies depending on the reason for the surgery and the extent of surgery. In general, patients may spend a few days in the hospital after the surgery and take several weeks to fully recover.

Is a craniotomy a safe procedure?

Like any surgical procedure, a craniotomy carries some risks, such as bleeding, infection, and stroke. However, modern techniques and technology have made craniotomy a relatively safe procedure.

What are the potential complications of a craniotomy?

Complications can include bleeding, infection, seizures, stroke, and brain damage. However, with proper medical care and management, these complications can often be avoided or treated.

Will I have to shave my head for a craniotomy?

It depends on the location of the surgery. In some cases, only a small area of hair needs to be shaved. However, for larger surgeries, a larger portion of the head may need to be shaved.

How is a craniotomy performed?

The procedure starts by making an incision in the scalp, removing a portion of the skull, and accessing the brain. The surgery is performed under general anesthesia, and the patient is monitored throughout the procedure.

How long does a craniotomy procedure usually take?

The duration of the procedure depends on the reason for the surgery and the extent of the procedure. It can range from a few hours to several hours.

How long will I stay in the hospital after a craniotomy?

The duration of the hospital stay depends on the extent of surgery and the patient's needs. Patients may stay in the hospital for a few days to a week or more.

What can I expect during recovery after a craniotomy?

Recovery involves pain management, wound care, and rehabilitation. Patients may also need to undergo physical and occupational therapy to help regain function.

Can I drive after a craniotomy?

Patients should not drive until their doctor clears them to do so. This may take several weeks to a few months.

What kind of anaesthesia is used during a craniotomy?

General anaesthesia is used during a craniotomy, which means the patient is unconscious for the procedure.

How long will I need to take off work after a craniotomy?

The length of time off work depends on the patient's job and the extent of the surgery. In general, patients can take several weeks to a few months off work to recover fully.

Will I have a scar after a craniotomy?

Yes, there will be a scar on the scalp where the incision was made. However, the scar can often be hidden by hair or other methods.

Can a craniotomy be performed on older adults?

Yes, a craniotomy can be performed on older adults, but it may carry higher risks due to age-related health concerns.

How long do I need to take medications after a craniotomy?

The length of medication use varies depending on the reason for the surgery and the individual patient's needs. Patients may need to take medications for several weeks to several months.

What is the difference between a craniotomy and a craniectomy?

A craniotomy involves removing a part of the skull to access the brain, while a craniectomy involves removing a section of the skull and not replacing it.

Can a craniotomy be done on children?

Yes, craniotomy can be done on children, but it depends on the child's age, the reason for the surgery, and other medical factors.

How long does it take to recover from a craniotomy for a brain tumour?R

Recovery time varies among people, but it generally takes several weeks to several months for a full recovery.

How long does it take to recover from a craniotomy for a traumatic brain injury?

The recovery time can vary between person to person, but it generally takes several weeks to several months for a full recovery.

How long does it take to recover from a craniotomy for epilepsy?

The recovery time can take several weeks to several months for a full recovery.

How long does it take to recover from a craniotomy for an aneurysm?

The recovery time generally takes several weeks to several months for a full recovery.

How long does it take to recover from a craniotomy for an AVM?

The recovery time takes several weeks to several months for a full recovery.

What kind of anaesthesia is used for a craniotomy?

General anesthesia is usually used for craniotomy.

What kind of imaging tests are done before a craniotomy?

MRI, CT scan, and/or angiography may be done before a craniotomy.

How is the location of the craniotomy determined?

The location of the craniotomy is selected by the location of concern in the brain.

What kind of monitoring is done during the craniotomy?

During a craniotomy, the patient is closely monitored for vital signs and brain function.

What kind of pain relief is provided after a craniotomy?

Pain medication like opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), may be provided after a craniotomy.

Can I drive after a craniotomy?

No, it is not safe to drive after a craniotomy.

What kind of follow-up appointments will I need after a craniotomy?

The patient will need regular follow-up appointments with their doctor to monitor progress and ensure proper healing.

Can I resume normal activities after a craniotomy?

The patient should wait until they are cleared by their doctor before resuming normal activities.

How can I help prevent complications after a craniotomy?

The patient can help prevent complications by following their doctor's instructions, keeping the wound clean and dry, and avoiding activities that put strain on the head or neck.

Can a craniotomy be done for a stroke?

A craniotomy may be done in certain cases of stroke, such as to remove a blood clot.

Can a craniotomy be done for a brain abscess?

Yes, a craniotomy may be done to drain and remove a brain abscess.

Can a craniotomy be done for hydrocephalus?

A craniotomy may be done to treat hydrocephalus by inserting a shunt which drains excess fluid.

Can a craniotomy be done for meningitis?

A craniotomy may be done in certain cases of meningitis, such as to remove infected tissue.

Can a craniotomy be done for a pituitary tumour?

Yes, a craniotomy may be done to remove a pituitary tumour that cannot be reached by endonasal surgery. The surgeon will access the tumour through an opening in the skull and remove it.

How long does it take to recover from a craniotomy for a pituitary tumour?

The recovery time after a craniotomy for a pituitary tumour may vary depending on various factors, like the size of the tumour, its location, and the health of the patient. However, most patient return to normal activities within four to six weeks after the surgery.

Can a craniotomy be done for trigeminal neuralgia?

In some cases, a craniotomy may be done to treat trigeminal neuralgia if other treatments have been unsuccessful. During surgery, the surgeon will access the trigeminal nerve and either decompress it or cut it to relieve the pain.

How long does it take to recover from a craniotomy for trigeminal neuralgia?

Recovery time after a craniotomy for trigeminal neuralgia varies depending on the extent of surgery and overall health of the patient. However, most patients return to normal activities in two to four weeks after the surgery.

Can a craniotomy be done for facial nerve disorders?

In some cases, a craniotomy may be done to treat facial nerve disorders such as hemifacial spasms or facial nerve paralysis. During surgery, the surgeon will access the facial nerve and either decompress it or reposition it to relieve the symptoms.

How long does it take to recover from a craniotomy for facial nerve disorders?

The recovery time after a craniotomy for facial nerve disorders may vary depending on the extent of surgery and the overall health of the patient. However, patients can return to normal activities within four to six weeks after the surgery.

Can a craniotomy be done for a skull base tumour?

Yes, a craniotomy may be done to remove a skull base tumour that cannot be reached by endonasal surgery. The surgeon will access the tumour through an opening in the skull and remove it.

How long does it take to recover from a craniotomy for a skull base tumour?

The recovery time after a craniotomy for a skull base tumour relies on factors like the size and location of the tumour and overall health of the patient. However, most patients return to normal activities in four to six weeks after the surgery.