Craniotomies

A craniotomy [CRAY-nee-OT-oh-MEE] is a type of operation on the skull. It is a very critical operation. In it, a piece of bone is removed so that the brain can be accessed. Craniotomies allow doctors to access the parts of the brain that need repair, such as when there is bleeding in the brain, an injury, or brain lesions [LEE-shunz]. Learn more about craniotomy.

A craniotomy [cray-nee-OT-oh-mee] is a very critical type of operation. In it, a specially trained surgeon (a neurosurgeon) cuts out a “flap” in the skull so that the brain can be accessed. The piece of skull is replaced once the procedure has been completed.

Craniotomy is performed for a variety of reasons when doctors need to access the brain to stop bleeding, diagnose or remove a tumor, drain a brain abscess, or repair severe brain injuries or brain lesions [LEE-shunz], to name a few. Sometimes, a craniotomy is needed to treat Parkinson’s disease or epilepsy.

As a craniotomy is a major surgery often done during emergencies, there are some risks. These risks have more to do the part of the brain being worked on once the craniotomy opens up access to that part. For example, if the part of the brain that controls vision needs to be worked on, there may be more risks to the patient’s vision than there would be if a different part of the brain was being worked on.

There may be other risks that include, but are not limited to:

• Excessive bleeding
• Blood clots
• Blood pressure that goes too high or too low
• Vision problems
• Trouble speaking
• Memory problems
• Infection
• Muscle or general weakness
• Poor balance
• Swelling, even brain swelling
• Seizures
• Pneumonia
• Paralysis
• Coma

This procedure will also include any risks that are linked to the type of anesthesia that is needed to perform the procedure. Make sure you speak to your doctor and your brain surgeon about any risks that may be a part of this surgery. Tell them about your experiences with anesthesia in the past. Take the time to ask any questions you need to better understand your specific situation and the risks. 

There are many reasons you might benefit from a craniotomy, including that the procedure can:

• Help repair brain tissue, such as a membrane tear
• Remove blood clots
• Remove excess blood that is leaking in the brain
• Help diagnose or treat  a brain tumor
• Help drain an abscess [AB-sess] in the brain
• Help treat epilepsy or Parkinson’s disease
• Relieve pressure in the brain, often because of a severe brain injury

Your doctor may have other reasons why they suggest a craniotomy. Make sure you talk to your doctor to understand these reasons, and take the time to ask any questions you may have.

Take the time to discuss any questions you may have with your doctor before your procedure. Ask your doctor about what you can do to prepare based on your condition.

Before the procedure, make sure to tell your doctor:

• About all medicines you take including over-the-counter medicines, supplements, inhalers, liquid medicines, and patchesIf you think you are pregnant
• If you have any allergies, especially to latex or anesthesia
• If you have a history of bleeding too much or other bleeding problems

If you smoke, you should stop smoking to help your recovery go better.

Before your procedure, you:

• Will have a complete physical exam to make sure you are in good health
• May also be asked to have a blood test before the procedure
• Will be asked to sign a consent form
• Will be given a neurological [NOO-roh-LAH-jik-uhl] (brain) exam, which will be compared to exam results after the surgery
• Will be asked to follow your doctor’s instructions on when to stop eating or drinking before the procedure 
• May be asked to use a special shampoo the night before your procedure that helps get rid of bacteria on your scalp
• Will have the areas around the incision sites shaved
• May be given a sedative [SED-uh-tiv], a medicine that can help you relax
• Should avoid wearing any jewelry to the hospital for your procedure 

Most of the time, patients that have a craniotomy will need to stay at the hospital for 3 to 7 days. Your doctor may also recommend other rehabilitation, depending on the type of your procedure.

During the procedure, you:

• Will be given a hospital gown to wear
• Will have an IV placed in a vein in your hand or arm for the anesthetic and fluids during the surgery
• Will have a catheter put in your urethra [yoo-ree-thruh] to drain any urine
• Will be placed on the operating table in a way that gives that doctor the best access to the part of the skull that needs to be operated on
• Once you are asleep, the surgeon will make an incision through the skin, pull back the scalp, and cut out a small section of your skull, called a bone flap. The bone flap is removed to expose the brain underneath.
• Perform the needed treatment for your condition, such as removing a tumor, stopping a bleeding artery, or draining an abscess.

Your surgeon might take other steps depending on your condition. Your doctor can tell you exact details about what your surgery will require.

After the surgery is finished, the surgeon will replace the bone flap using wires, stitches, and/or plates. The cut in the skin will also be sewn shut with stitches, and the wound will be bandaged. You will be taken to the recovery room to wake up from the anesthesia [ann-ess-THEE-see-uh] and for general observation.

You may need to stay in the ICU (Intensive Care Unit) during your hospital stay after this procedure. While in the ICU, you will be given medicines that help reduce the swelling in the brain and also help control pain. When you are ready, you will typically be moved out of the ICU and to a room in the neurosurgery unit of the hospital for perhaps a few more days.

Some patients will need to stay on oxygen right after the surgery but will usually be taken off of it before they go home. 

The results of your brain surgery will depend on the reason for the surgery in the first place. For example, if your surgeon performed a craniotomy to remove a tumor, you will likely find out within a few days whether or not the tumor is a type that spreads and what treatment next steps might be. If the craniotomy was to repair an artery, your surgeon will likely be able to tell you how successful the surgery was soon afterwards.

Most craniotomies themselves take somewhere between 4 and 8 weeks to heal. Each procedure is different. Talk to your doctor about what to expect from recovery.

After the surgery, you will stay at the hospital while you recover. Your follow-up appointments and treatment will depend on the reason why your surgeon needed to get access to your brain in the first place.

In general, you can expect that:

• You will receive many neurological checks during your stay in the hospital to make sure you are recovering well. Your checkups will include strength tests for your arms and legs as well as observation of how well you can follow simple commands and answer questions. Your pupils will also be checked with a flashlight.
• Some patients are also given a catheter during their hospital stay. Talk to your doctor before the procedure to know if this is something that may happen for you and how to watch for signs of infection after you go home.
• Before discharge from the hospital, several follow-up exams will be set so that your doctors can continue to monitor your recovery.
• Your head may hurt for a while after this procedure. Talk to your doctor before taking any pain medicines that have not been prescribed.

Make sure to follow your recovery plan from your doctor. If you have any questions, make sure to ask them so you can recover as quickly as possible.

DO NOT drive until your doctor has told you it is okay to do so.

Call your doctor if you have any of the following symptoms:

• Fever
• Excessive redness, swelling, or bleeding from the incision site or from your face
• Drainage from the incision site or face
• Confusion
• Fatigue
• Weakness in the arms and legs
• Changes in your vision
• Trouble speaking
• Trouble breathing
• Chest pain
• Anxiety
• Seizures or seizure-like activity
• Sputum (phlegm) that is green, yellow, or bloody

Ask your doctor if there are any other instructions you should follow that are specific to your exact procedure.

As this is a critical procedure, there will be several follow-up exams and requirements. These requirements are specific to each case. Talk to your doctor to know about what you may be required to do after your procedure.