A craniotomy is a surgical procedure in which some part of the skull bone is removed to get access to the brain. The bone is removed temporarily and is sewed back onto the skull after the surgery. Craniotomy surgery is performed for treating various following conditions:
Removal of blood clots after traumatic injury
Arteriovenous malformations in the brain
Draining brain abscess
Treating epileptic seizures
For implanting brain-stimulating devices in certain conditions like Parkinson’s disease
Types of craniotomy surgery
Depending upon the technique, this surgery has two types:
It involves the use of a CT scan or MRI to spot the exact location for the operation.
It involves using an endoscope, which is a kind of camera inserted to visualize the insides of the brain.
Depending upon the location, craniotomy surgery can be of the following types:
Extended bifrontal craniotomy
This procedure removes the tumors lying in front of the brain. The incision is made on the hairline and the frontal bone (which forms the curve of the forehead) is removed to get access to the brain.
Retro-sigmoid or Keyhole Craniotomy
This is a minimally invasive procedure in which an incision is done behind the ears to remove the brain tumotrs, especially the skull base tumorrs.
Supra-orbital 'Eyebrow' Craniotomy
In this technique, the cut is made on the eyebrow region to remove small tumors of the pituitary gland that are situated deep into the eyes and nose.
This procedure is carried out for removing complex tumors - especially those of the pituitary gland - which cannot be removed through other techniques. For carrying out this surgery, an incision is made in the orbital area behind the hairline to remove tumors located in the orbital and cheekbone regions.
The incision is made behind the ears, and some part of the ear bone is removed to access the brain. However, since there is a chance of hearing loss with this technique, it is performed when other methods do not work effectively.
Skull and brain
How is a Craniotomy surgery is performed?
Craniotomy surgery is usually performed under general anesthesia. However, it can be performed under local anesthetic (awake craniotomy) by numbing the head’s particular side. The patient is positioned carefully as per the surgical technique to avoid pressure on the sensitive areas.
After that, the hair is shaved, and the area is cleaned and disinfected using an antiseptic.The doctors use a craniotomy drill or craniotome to drill the skull bone. Small adjacent holes are drilled on the skullcap by carefully separating the bone from the dura mater, which is one of the outer coverings of the brain. The holes are connected using a craniotome saw, and a bone flap is lifted.
Retractors are used to retract the tissues and make the surgical field visible and accessible until surgery completion. After the procedure is completed, the bone flap is again placed over the brain and attached using titanium screws.
Preparation before a Craniotomy
Before proceeding with a surgery, the following tests are performed to evaluate the patient’s health and wellbeing:
Imaging tests: Brain scans like CT, MRI, and angiography to locate the brain lesions.
Routine tests: Blood profile (complete blood count, prothrombin tests, blood group, etc.), liver and kidney function tests.
Medications: The patients are asked to stop blood-thinning medications 7-10 hours before the procedure. Medications like antibiotics, corticosteroids, and anti-seizure drugs are given to the patient before the surgery to prevent any infection, swelling, and seizures.
Preoperative testing: Clearance from the heart and medicine department, which involves taking chest X-rays, ECG, blood tests, etc., also needs to be achieved before surgery.
Diet: The patient should have an empty stomach on the day of the surgery. Fasting overnight is desirable.
Follow-up Craniotomy surgery
Follow-up is a crucial part of any surgical procedure. The patient is asked for a follow-up after a week. Some tests are repeated to ensure the procedure's success and to check for any signs of recurrence.
It is always recommended to follow the neurosurgeon’s advice until complete recovery. The doctor might advise you to avoid any strenuous activity for some time.
After 7-10 days, the patients are asked to move slightly to increase brain activity. The doctors may also assess your movements, speech, memory, etc., to ensure regular brain activity post-surgery.
Risks associated with Craniotomy surgery
One of the common risks associated with craniotomy surgery is post-operative pain, which can sometimes be unbearable. To counter that pain, certain medications are prescribed, like nerve blocks, morphine, etc. Other risks or complications associated with craniotomy are:
Meningitis: It is a common infection caused by bacteria, viruses, and fungi in the brain tissues.
Osteomyelitis of the bone tissues: It occurs if there is a bacterial infection in the bone
Wound infection: It occurs because of inadequate care of the incision wound post-surgically.
Cerebrospinal fluid leakage: It can occur because of the tearing in the skull’s dura mater after surgery.
Seizures: Especially occur in patients who already have seizures or epilepsy.
Laceration of underlying tissues of the brain
Other severe but uncommon risks associated with this surgery are
Recovery after Craniotomy surgery
It usually takes 6-12 weeks post-surgery to get completely healed from the craniotomy procedure. Healing depends on the type of lesion for which the craniotomy was performed and the patient’s general health factors. Post-surgery, general tiredness and weakness are common, which can be overcome by proper rest, taking a nutritious diet, and following the doctor’s recommendation. Complete bed rest is usually advised to restrict all the activities that can make the patient tired. Follow-up should be performed after a week or per your neurosurgeon’s advice. It is recommended to stay in touch with the doctors for optimum recovery from the procedure.