Craniotomy

What is a craniotomy?

A craniotomy is a type of brain surgery where a neurosurgeon will open and remove a piece of your skull to access your brain. During the same surgery, your surgeon will reapply the piece of your skull. A craniotomy is a major surgery. A surgeon usually considers this type of treatment after diagnosing a brain tumor or life-threatening condition or after a traumatic brain injury.

What is the difference between a craniotomy and a craniectomy?

While both a craniotomy and a craniectomy are types of brain surgery, they’re different procedures. A craniotomy removes and replaces a piece of your skull to access your brain. A surgeon will also remove a piece of your skull during a craniectomy, but the removed piece of skull isn’t immediately put back into place after surgery. You may need a follow-up surgery called a cranioplasty to replace the missing part of your skull.

What are the types of craniotomy?

There are several types of craniotomy procedures. Their names relate to the location where your surgeon will remove a piece of your skull to access your brain. Types of craniotomy surgeries include:

• Frontal: The front of your skull near your hairline.
• Temporal: Part of your skull next to your eyes and in front of your ear.
• Parietal: The top-middle and upper back of your skull.
• Pterional (frontotemporal): The side of your skull, behind your temple.
• Orbitozygomatic: Part of your skull near your eye socket and cheek.
• Retrosigmoid (keyhole): A small incision in the area of your skull behind your ear.
• Suboccipital: The base of your skull, above your neck.

What does craniotomy treat?

You may need a craniotomy to treat:

• A tumor.
• A blood clot.
• An abnormal collection of blood vessels (vascular malformations).
• Tangled blood vessels (arteriovenous malformation).
• An artery enlargement (aneurysm).
• Swelling or pressure in your brain.
• Epilepsy.
• A skull fracture.

How should I prepare for a craniotomy?

Before craniotomy surgery, you’ll meet with your surgeon, who’ll carefully plan the procedure. They’ll order several tests to assess your health and the reason for your surgery. Tests also help your anesthesiologist determine how much anesthetic to give during your procedure. You may need the following tests before a craniotomy:

• Physical examination.
• Blood tests.
• Imaging tests (MRI, CT scan, PET scan or angiography).

Your surgeon will let you know how you can prepare for your surgery, which may include:

• Arriving on the day of your surgery on an empty stomach.
• Stopping any blood-thinning medications three to 10 days before your surgery.
• Taking antibiotics, anticonvulsant medications or corticosteroids before the day of your surgery.

In addition, your surgeon will discuss the results of your tests with you and explain the procedure. They’ll also explain the side effects of the treatment, your healing time and what to expect after surgery. If you have any questions about the surgery, ask your surgeon before the day of your procedure.

What happens during a craniotomy?

On the day of your craniotomy surgery, an anesthesiologist will give you anesthesia. This will make it so you don’t feel any pain. In the operating room, your surgical team will adjust the position of your head and body to avoid putting pressure on any points.

Your surgeon will begin by shaving any hair near the incision site, and they’ll sterilize (use iodine or alcohol to kill any germs and reduce your risk of infection) your head. Then, they’ll make an incision or opening in your skin. The location of the opening varies according to the type of craniotomy you need. Your surgeon will adjust or move the muscles around your skull. Next, your surgeon will drill several holes and cut in between each hole with a medical saw to remove a piece of your skull. After removing the piece of your skull, your surgical team will place it on a surgical instrument table so they can use the same piece to close up your skull at the end of your surgery.

Next, your surgeon will remove or repair your brain according to the reason for your surgery.

Once your surgeon treats your brain condition, they’ll fit your skull back into place like a puzzle. Then, your surgeon will move any muscles or tissue back into place and close up the incision in your skin.

Are you awake during a craniotomy?

Some types of craniotomy procedures require you to be awake for the surgery. This happens if your surgeon needs to see how your brain functions, especially if they’re working on the part of your brain that controls your movement, speech or vision. During an “awake” craniotomy, you’ll receive a localized anesthetic so you won’t feel any pain, and it won’t make you fall asleep.

How long does a craniotomy procedure take?

Craniotomy procedures can take three to five hours, but they can last longer depending on what your surgeon needs to do.

What happens after a craniotomy?

After a craniotomy, you’ll move into the intensive care unit (ICU) in a hospital. Here, your care team will monitor your healing until you’re able to move out of the ICU. You’ll need to stay in the hospital for up to a week after your surgery.

You’ll need to stay in bed with your head elevated as you recover. Your care team will keep track of your vitals and give you medications as needed to provide comfort and prevent complications.

When you’re ready to leave the hospital, you’ll receive instructions so you can finish recovery at home. The main focus of your recovery is rest.

What are the benefits of a craniotomy?

The benefits of a craniotomy vary based on the reason for surgery. The main benefit is that it treats the cause of the surgery, which could include:

• Removing a tumor.
• Treating an underlying condition.
• Repairing blood vessels, bones or components of your brain.

Most reasons for a craniotomy are to prevent life-threatening complications, which will improve your life expectancy.

How successful is a craniotomy?

The success rate of a craniotomy surgery depends on many factors and the reason for the surgery. Modern medicine and practices make this type of surgery safe and effective in treating several types of causes.

What are the risks or complications of a craniotomy?

The possible risks and complications of a craniotomy include, but aren’t limited to:

• Bleeding.
• Pain.
• Hematoma.
• Seizures.
• Stroke.
• Coma.
• Hydrocephalus.
• Infection.
• Headaches.

Some types of craniotomies can be life-threatening. Your surgeon will explain these risks and work with your care team to prevent any complications from affecting you during and after your surgery.

What are the long-term side effects of a craniotomy?

While rare, a craniotomy can affect your ability to think, move, speak and function normally. Some long-term side effects could include:

• Difficulty walking.
• Problems with balance and coordination.
• Trouble with speech and pronunciation.
• Changes to your behavior.
• Changes to your appearance due to scarring.

What is the recovery time for a craniotomy?

The average recovery time for a craniotomy is about six to eight weeks. You’ll also spend around one week in the hospital after your surgery. Your care team will let you know how long you’ll need to rest before getting back to your normal activities, including work or school. You shouldn’t participate in any physically demanding activities until your healthcare provider says it’s safe to do so.

Do I need follow-up appointments with certain providers after a craniotomy?

Yes, you’ll need to schedule several follow-up appointments with your care team to monitor your progress after surgery. Your care team may include a:

• Surgeon.
• Primary care physician.
• Neurologist.
• Physical or occupational therapist.
• Speech therapist.

What is the life expectancy after a craniotomy?

A healthcare provider will consider many factors, including your general health and the extent of your surgery when estimating your life expectancy after a craniotomy. Your surgeon can explain the risks associated with your surgery before it begins so you can make an informed decision about your care.

Can you live a normal life after a craniotomy?

Yes, it’s possible to live a normal life after a craniotomy. Many people make a full recovery after surgery and have minimal side effects or complications.

When should I call my healthcare provider?

Talk to a healthcare provider if:

• Your surgical site isn’t healing.
• You experience severe pain and swelling.
• You have a fever.

Call your local emergency services number or 911 if:

• You have signs of a stroke.
• You have trouble breathing.
• You have a seizure.

A note from Cleveland Clinic

A craniotomy is a major type of brain surgery where your surgeon will remove and replace part of your skull to access your brain. You may have a lot of emotions before undergoing a major type of brain surgery like a craniotomy. Your care team will be available to answer any questions you might have and help you prepare for your surgery. After the procedure, you’ll need plenty of rest and several follow-up appointments to make sure you’re healing as expected.