Craniotomy: What It Is, Procedure, and Recovery Process

A craniotomy is a surgical process in which the skull’s portion, known as the bone flap, is temporarily removed to provide access to the brain. This operation is performed by a neurosurgeon using specialised tools to carefully remove and later replace the bone flap after the necessary procedure is completed. A craniotomy is considered a major brain surgery and is typically recommended for conditions such as brain tumors, blood clots, epilepsy, traumatic brain injuries, or other life-threatening neurological disorders.

The procedure involves making an incision in the scalp, carefully removing the skull section, and addressing the underlying brain condition. Once the surgery is finished, the bone flap is secured back in place, and the incision is closed. Since the brain is a delicate organ, craniotomy procedures require extreme precision and expertise to minimize risks and complications.

Recovery from a craniotomy varies from patient to patient, but initial healing generally takes up to two months. During this period, patients may experience headaches, fatigue, or temporary cognitive challenges. Post-surgical care and rehabilitation play an important role in ensuring a successful recovery.

Craniotomies are life-saving procedures that allow surgeons to directly access and treat brain abnormalities. Despite being a major surgery, advancements in neurosurgical techniques have significantly improved outcomes, making it a vital option for patients with serious brain conditions.

Types of Craniotomy Procedures

There are several types of craniotomy procedures, each named based on the location of skull removal:

• Frontal Craniotomy: Accesses the brain through the front of the skull.
• Temporal Craniotomy: Performed near the temples.
• Parietal Craniotomy: Targets the top-middle and upper back of the skull.
• Orbitozygomatic Craniotomy: Involves removing bone near the eye socket and cheek to access deeper brain regions.
• Keyhole Craniotomy: A minimally invasive procedure performed through a small opening behind the ear.

The Procedure of a Craniotomy

Preparation 

Before undergoing a craniotomy, the patient will meet with the surgeon for a thorough evaluation and surgical planning. Several tests are conducted to assess the patient’s overall health and the specific brain condition that requires treatment. 

• Physical examination to assess the patient’s general health.
• Blood tests to check for any primary medical conditions.
• Imaging tests such as MRI, CT scan, PET scan, or angiography provide detailed views of the brain and pinpoint the exact area requiring surgery.

To prepare for the process, the surgeon may receive additional requests from the patient, such as fasting or pausing medication. The surgeon will also explain the possible risks, side effects, recovery timeline, and what to expect during and after the surgery.

Steps of a Procedure

On the day of the surgery, the patient is administered general anaesthesia to ensure they remain unconscious and pain-free throughout the procedure. However, in some cases, such as an awake craniotomy, only local anaesthesia is used to allow the surgeon to monitor brain function in real-time.

1. The patient is securely positioned to allow the surgeon optimal access to the affected brain area.
2. The surgeon makes an incision in the scalp based on the location of the treated brain condition. The scalp and underlying tissues are carefully moved aside to expose the skull.
3. Once the brain is exposed, the surgeon performs the necessary treatment, which may include:
   • Removing a tumour or abnormal tissue.
   • Clipping or repairing an aneurysm.
   • Draining a blood clot or abscess.
   • Correcting vascular malformations or relieving brain swelling.
   • Implanting medical devices for movement disorders.
4. After completing the necessary brain procedure, the surgeon carefully replaces the bone flap, securing it with titanium plates and screws. The muscles and tissues are repositioned, and the scalp incision is sealed with sutures or staples.

Post Operative Care

Following the craniotomy, the patient will be moved to the intensive care unit (ICU) for supervision. The medical team tracks vital signs, manages pain, and prevents complications such as infection or swelling.

• Patients have to stay in the hospital for several days to a week after surgery.
• Head elevation and bed rest are required to reduce pressure and promote healing.
• Medications, including pain relievers and anti-seizure drugs, may be suggested to alleviate symptoms and prevent complications.
• Imaging tests need to be performed to assess the success of the surgery.

Healing After a Craniotomy: Timeline and Care Tips

A craniotomy is a critical surgical procedure used to treat various brain conditions. While it is complex and delicate, advancements in neurosurgical techniques have improved patient outcomes and reduced risks. Proper preparation, skilled surgical execution, and thorough post-operative care are essential for a successful recovery. Patients undergoing craniotomy can expect a gradual healing process, typically taking several weeks to months, depending on the complexity of the procedure and the individual’s overall health.

Frequently Asked Questions