A craniotomy is a surgical procedure used to view the brain. In this surgery, a part of piece of the skull – called the “bone flap” – is removed to directly see the brain. More commonly, craniotomies are performed to remove brain tumors. After the necessary procedure is completed, the bone flap is carefully fitted back into the skull.
Craniotomies may seem like an aggressive treatment option. However, this is the most effective way to treat both malignant and benign brain tumors. These surgeries are performed by neurosurgeons only.
Craniotomies are categorized differently based on the the section of the skull that needs to be temporarily removed. A frontotemporal, parietal, temporal or suboccipital craniotomy is named after the removed bone. For accuracy and precision, your surgeon may use imaging devices to guide him/her. This type of procedure is known as a stereotactic craniotomy.
During stereotactic craniotomy, scans help create a three-dimensional (3D) images of the brain. A connected computer supplies a navigation pathway to the surgeon, so that he/she can precisely locate the tumor.
The Craniotomy Procedure
A craniotomy is performed in a hospital, sometimes under general anesthesia. The incision site on the scalp is first shaved off. This allows easy access to the surgeon and also prevents potential infections. An incision is made in the scalp and the bone flap is carefully removed. If a patient is asked to remain awake during surgery, he/she may be asked to recite the alphabet or move their legs. This is done to confirm proper brain function.
The incision site depends on the section of the skull that needs to be temporarily removed. Different tools may be used depending on the location, such as a medical drill to create small holes or a special saw. After the bone flap is removed, another incision is made in the ‘dura mater’ – the material that covers the brain. After this, the tumor is quickly located and completely removed (if possible). To finish the procedure, the surgeon will stitch together any cut tissue. The bone flap will then be reattached firmly through plates, sutures or wires.
Your surgeon may be unable to remove the entire tumor; it depends on the location of the tumor. In this case, surgery is still a good option as it can relieve symptoms and help reduce pressure within the brain. If the tumor has been only partially removed, additional treatment, such as radiation therapy, may be required to destroy any remaining tissue.
Risks Of Craniotomy
Surgery to treat a brain tumor is understandably complex. This surgery has some risks and potential complications. Risks may be related to the specific operation site. For example, if the part of the brain needing operation controls speech, then your speech may be affected. Swelling may occur on the operated site, as can accumulation of fluid. This can lead to brain damage and other serious complications. Healthy brain tissue may also be damaged, creating problems with speaking, thinking, and eyesight. Other risks include more generalized possibilities, such as bleeding, infection, and blood clots. Aside from the usual surgical risks of infection, bleeding and blood clot formation, other risks specific to craniotomy include swelling and fluid accumulation, which can lead to brain damage and other serious complications.
Recovery from Craniotomy
After a craniotomy surgery, a patient usually has a headache for a couple of days. He/she may also feel tired and weak. Patients typically spend three to seven days in the hospital, depending on their situation and recovery speed. The surgeon will prescribe pain medication to help with healing and relieve pain. The patient will not be allowed to drive, lift heavy objects, or do a variety of common daily activities until cleared by the surgeon.
If the brain tumor is determined to be malignant during the craniotomy, additional treatment may be necessary. Treatments include radiation therapy, which uses high energy X-rays or gamma rays to destroy malignant cells. Chemotherapy may also be necessary, which involves the use of drugs administered intravenously (via an IV).