Craniotomy Surgery

Overview

A craniotomy is a surgical procedure in which a portion of the skull bone is temporarily removed to access the brain. This surgery is performed to address several conditions, including:

Removal of blood clots after traumatic injury
Brain tumors
Brain aneurysms
Arteriovenous malformations
Draining brain abscesses
Treating epileptic seizures
Implanting brain-stimulating devices for conditions like Parkinson’s disease

Alternate Name for Craniotomy Surgery

Also known as brain surgery.

Body Location

Skull and brain.

Craniotomy Procedure Type

Surgical procedure.

Types of Craniotomy Surgery

Based on Technique:

Stereotactic Craniotomy: Utilizes CT or MRI imaging to pinpoint the exact surgical site.
Endoscopic Craniotomy: Involves the use of an endoscope for visualization during the procedure.

Based on Location:

Extended Bifrontal Craniotomy: Accesses tumors in the front of the brain through an incision along the hairline and removal of the frontal bone.
Retro-Sigmoid (Keyhole) Craniotomy: A minimally invasive technique using an incision behind the ear to remove skull base tumors.
Supra-Orbital ‘Eyebrow’ Craniotomy: Targets small pituitary gland tumors through a cut near the eyebrow.
Orbitozygomatic Craniotomy: Removes complex tumors in the orbital and cheekbone regions via an incision behind the hairline.
Translabyrinthine Craniotomy: Involves an incision behind the ear and removal of part of the ear bone to access the brain, often with a risk of hearing loss.

Preparation Before Craniotomy Surgery

Tests and Imaging:

Brain scans (CT, MRI, angiography) to locate lesions.
Routine blood tests, liver and kidney function tests.

Medications:

Discontinuation of blood-thinning medications 7–10 days before surgery.
Administration of antibiotics, corticosteroids, and anti-seizure medications to prevent infection, swelling, and seizures.

Preoperative Clearance:

Approval from cardiology and internal medicine teams, often requiring chest X-rays, ECG, and blood tests.

Diet:

Fasting is required overnight before surgery.

How Craniotomy Surgery Is Performed

Performed under general or local anesthesia, depending on the technique.
Hair is shaved, and the surgical area is disinfected.
A craniotomy drill is used to create adjacent holes in the skull, which are connected using a saw to lift the bone flap.
The bone flap is reattached after the procedure using titanium screws.
Advanced tools like retractors and imaging systems may be employed to enhance precision and safety.

Follow-Up After Craniotomy Surgery

Follow-up care includes:

A visit to the neurosurgeon within a week.
Repeating imaging or other tests to monitor recovery.
Gradual movement and light activities are encouraged after 7–10 days to stimulate brain function.
Avoiding strenuous activities until advised.

Risks Associated with Craniotomy Surgery

Common risks include:

Post-operative pain managed with medications like nerve blocks or morphine.
Infections: Meningitis, osteomyelitis, or wound infection.
Cerebrospinal Fluid Leakage: Caused by tearing in the dura mater.
Seizures: Especially in patients with pre-existing epilepsy.

Rare but severe complications:

Coma
Impairments in speech, memory, or movement

Recovery After Craniotomy Surgery

Full recovery typically takes 6–12 weeks, depending on the condition treated and overall health.
Common post-surgery symptoms include fatigue and weakness, which can be alleviated by rest, a nutritious diet, and following medical advice.
Bed rest is recommended initially, followed by gradual resumption of activities as advised by the neurosurgeon.

Frequently Asked Questions

1. Will I have a visible scar after craniotomy surgery?
Surgeons aim to minimize scarring by placing incisions in discreet areas. The size and location of the scar depend on the procedure.

2. Can craniotomy surgery be minimally invasive?
Yes, techniques like endoscopic and keyhole approaches are available for certain conditions, depending on the patient and surgeon expertise.

3. What is the success rate of craniotomy surgery?
Success rates are generally high, varying with the condition treated, patient health, and surgical expertise.

4. Will I require an ICU stay after surgery?
Some patients may need ICU care for close monitoring, while others may be transferred to a regular ward based on their condition.

5. Is advanced technology used during craniotomy surgery?
Yes, tools like neuronavigation systems, intraoperative imaging, and neurophysiological monitoring enhance precision and safety.

Craniotomy surgery is a critical procedure for addressing various brain conditions. Proper preparation, skilled surgical techniques, and comprehensive follow-up care are key to a successful recovery.

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