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Craniotomy: An Explanation

Medically reviewed by Abhay Sanan, MD, Susan Kerrigan, MD and Marianne Madsen on January 15, 2022

Before a brain surgery is performed, the skull must be opened to provide access to the brain. This procedure is called a craniotomy, and it is done in different ways for different reasons.


Why is a craniotomy performed?


A craniotomy is done to treat a wide variety of brain disorders, to implant a medical device, or to diagnose a tumor. Some problems and conditions that may require a craniotomy include:


  • Blood clots
  • Brain swelling
  • Infection
  • Epilepsy
  • Nerve problems
  • Blood vessel problems
  • Brain injury
  • Brain tumor
  • Parkinson’s disease
  • Brain aneurysm 
  • Biopsy
  • Skull fracture


Types of craniotomies


A craniotomy is not a simple procedure. Many different kinds of craniotomies exist, and all of them are done through varying methods. Some of the most common craniotomies include:


  • Endoscopic craniotomy, where a specialized camera is inserted through a small hole (called a “burr hole”) in the skull to record an image of the brain. 
  • Fronto-temporal craniotomy, an efficient, routinely used method of craniotomy that is used for a variety of purposes (mostly removal of tumors and repairing aneurysms).
  • Stereotactic craniotomy, which guides the surgeon to the site of a tumor using the assistance of imaging technology.
  • Keyhole craniotomy, a minimally invasive procedure to remove brain tumors through small openings in the skull.
  • Eyebrow craniotomy, another minimally invasive operation where bone is removed from the eyebrow area to open the skull and remove brain tumors.
  • Extended bifrontal craniotomy, which is done to remove tumors from the front of the brain.


Next Video >>

Cerebral Aneurysm - Craniotomy

Cerebral Aneurysm - Craniotomy

Risks of a craniotomy


All brain surgeries are considered high-risk procedures. Complications of a craniotomy are uncommon but can include:


  • Infection
  • Bleeding 
  • Blood clotting
  • Seizures
  • Swelling
  • Problems with memory or speech


Rarely, more serious complications can arise, such as:


  • Coma
  • Paralysis
  • Heart attack


What happens during a craniotomy?


Because there are so many methods of performing a craniotomy, the procedure is different depending on the problem at hand. But the general process is more or less the same, no matter what brain problem is being treated. On average, a craniotomy takes three hours, but it can take longer depending on the reason for the operation. Here’s what you can expect on the day of your surgery.


  1. In the operating room, you will receive anesthesia.
  2. Your head will be fitted into a clamp, so the surgeon can operate with ease.
  3. Part of your head will be shaved so the incision can be made.
  4. The surgeon may use your MRI scan as a reference.
  5. An incision in your skin will be made to ready the area for the craniotomy.
  6. A hole will be drilled in your skull and a piece of bone (called the bone flap) will be removed.
  7. The brain’s protective covering (called the dura) will be cut open to expose the brain.
  8. The surgeon will begin the operation. 
  9. After the operation has been successfully completed, your skull will be closed back up, using a metal plate and two screws.


Next Video >>

Craniotomy - Follow Ups

Craniotomy - Follow Ups

After the procedure


After the craniotomy is complete, you will be taken to a separate room to recover. The anesthesia will still be in effect, and as it wears off, your vital signs will be monitored. Once you are fully awake, you will be relocated to an intensive care unit (ICU). A nurse will ask you to move your arms, legs, and fingers and ask you a few questions to make sure your brain is functioning properly. You may receive medication to reduce brain swelling during your stay in the ICU.


In total, you will need to be in the hospital for 2 or 3 days. If complications arise, however, you’ll need to remain longer.


What happens after I’m released from the hospital?


Before you’re discharged from the hospital, your doctor will give you a list of instructions. This list includes which medications you should take and how you should care for yourself. 


You will likely be in pain for a time after the surgery, so you will likely be prescribed opioid painkillers. They are meant to be used only for a short time, as they are addictive. If you’re still experiencing pain after discontinuing opioid treatment, you can use acetaminophen (Tylenol).


Your doctor will tell you not to operate any vehicles or lift heavy objects. In addition, you’ll need to refrain from doing any jobs around the house (lawn mowing, vacuuming, washing clothes, etc). A full list of restrictions will be given to you in the hospital. 


You’ll be asked to avoid moderate or strenuous exercise; however, walking and stretching are permitted. 


Approximately two weeks after the operation, you will attend a follow-up appointment with your doctor, where you can discuss the next steps in the recovery process.


Written by Natan Rosenfeld

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