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The Day of Your Craniotomy

Craniotomy is a surgical opening made in the skull for treatment of several types of problems in the brain.  Special tools are used to remove a piece of the skull and allow access to the brain for surgical treatment. The most commons reasons for having a craniotomy include blunt or penetrating head trauma, tumors, aneurysyms and arteriovenous malformations (AVM), and brain abscess.

Arrive at the hospital on time. You may still have concerns and are likely to feel a bit nervous. Your healthcare team will try to answer all your questions. They will also do all they can to put you at ease.

Just before surgery

Side view of head with skull inside. Four small holes are in skull at corners of rectangle. Bone inside rectangle is removed.

The healthcare provider in charge of your anesthesia will talk with you before surgery. You will be given general anesthesia to help you “sleep” through the surgery. At some point, an IV (intravenous) line is placed in your arm. This line can supply medicine and fluids as needed. In many cases, some or all of your hair is shaved. This is done to decrease the risk of infection.

Reaching the brain

The surgeon makes an incision in your scalp. Then dime-sized burr holes are drilled in the skull. The bone between the holes is cut and lifted away. The surgeon then opens the dura, exposing the brain. The next step will depend on your specific problem. In some cases, certain nerves may be stimulated while the response in the brain is monitored. This is done to make sure that normal brain tissue is not disturbed during the surgery.

Finishing the craniotomy

When the goal of surgery is met, the dura covering the brain is closed. Sometimes, a dura substitute is used in place of your dura. Usually, the skull bone is put back and held in place with wire mesh, screws or metal plates. If there is too much brain swelling, your surgeon might choose not to put back the bone flat. It can be put back at a later time.  On occasion, a metal mesh is used if the bone cannot be used again or if there is a bone infection (known as osteomyelitis). If blood or fluid remains in the brain tissue, a drain may be placed through a burr hole for a few days. Most of the time, the burr holes are filled or covered  with metal plates right before closing the skin. Then the skin incision is closed with stitches or staples.

 

Risks of surgery

Risks of a craniotomy are:

  • Seizure (jerking movements or loss of consciousness) 

  • Infection

  • Loss of memory or confusion

  • Swelling or bleeding in the brain

  • Blood clots

  • Loss of sensation, including vision

  • Weakness or paralysis

  • Death

 

Note to family and friends

You can wait in a nearby room during surgery. Craniotomy often takes 3 to 5 hours, or more, to complete. If possible, be sure someone is always in the waiting room to receive any news. The doctor will come talk with you as soon as surgery is over. You’ll also be told when you can visit your loved one.

 

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