Craniectomy and Craniotomy Brain Surgery

Candidates for a Craniectomy and Craniotomy

Patients who undergo a Craniectomy or Craniotomy have generally suffered a traumatic brain injury that caused swelling or infection of the brain, have a brain tumor, hematoma, aneurysm or an arteriovenous malformation (AVM). If the patient has suffered an injury, a Craniectomy or Craniotomy may be necessary to relieve pressure on the brain from swelling. If undergoing surgery to treat a brain tumor, hematoma (blood clot), aneurysm (bulging artery) or AVM (tangle of blood vessels), a Craniectomy or Craniotomy may be necessary to access the part of the brain where the condition is located.

In a Craniotomy, the flap of the bone that was removed during surgery is replaced or covered with plates and screws. If the portion of the skull is not replaced or covered after the surgeon repairs the problem, the procedure is called a Craniectomy.

What are a Craniectomy and Craniotomy?

A Craniectomy or Craniotomy can vary in size and severity. In some cases, only a small “burr hole” is required to relieve pressure or access the brain. In these cases, the hole created in the skull is about the size of a dime. A “keyhole” is slightly larger; about the size of a quarter. These minimally-invasive techniques may utilize visual guidance with the assistance of stereotactic frames, computer imaging or endoscopes to carefully and accurately lead instruments through the small holes. Examples of procedures performed through a burr hole or keyhole may be to insert a shunt into the ventricle, insert a deep brain stimulator, insert an intracranial pressure monitor or acquire a tissue sample for biopsy.

In more complex cases, a larger portion of the skull is cut away to access a larger portion of the brain. A neurosurgeon will always keep the hole as small as possible. In a Craniectomy, the bone flap that is removed may be frozen and replaced months later once the patient’s brain has recovered.

In cases where the affected area is close to the part of the brain that controls speech, the patient may be awake during the procedure. In the initial steps of surgery when the bone is cut away, the patient is asleep. Then, he or she is awakened to read or talk while the surgeon places a probe on the brain surface to map the area at risk. These areas differ between patients and this technique helps the surgeon identify and protect the areas to preserve function.

Severe Craniotomies occur at the base of the skull where delicate cranial nerves, arteries and veins are supported by the skull. When the bone at the base of the skull requires removal, additional specialists may be called in for assistance in reconstructing the skull base.

Results of Craniectomy and Craniotomy Procedures

Immediately following surgery, the patient is awoken from anesthesia and transferred to the Intensive Care Unit (ICU) for close monitoring. Medical professionals will test motor functions and brain activity by asking the patient to move his or her arms, legs, fingers and toes and checking the patient’s pupils. The patient may also be asked general questions about themselves and about common knowledge to gauge his or her awareness. The patient may experience a sore throat from the breathing tube, nausea or a headache after surgery. Medication may be recommended to treat these symptoms.

If the patient experienced swelling of the brain, a steroid medication may be given. If seizures are a concern, an anticonvulsant may be given. Once the patient’s condition stabilizes, he or she will be moved to a regular room for continued recovery. The patient will undergo increased activity checks and may remain in the hospital anywhere from two days to two weeks, depending on the complexity of the surgery and any complications.

After being released from the hospital, a follow-up appointment is made 10-14 days following the procedure. Recovery may take one to four weeks. A full recovery may take up to eight weeks.

What are the risks of a Craniectomy and Craniotomy?

Every surgery comes with risk. As with most surgeries, risk of bleeding, infection, blood clots and negative reaction to anesthesia are present. Complications specific to a Craniectomy and Craniotomy include possible stroke, seizures, brain swelling, nerve damage, leaking of cerebrospinal fluid and loss of some brain function.

Risks and results are dependent on the underlying condition being treated and any complications during surgery or recovery.