What is a craniotomy?

A craniotomy is the surgical removal of component of the bone native the skull toexpose the brain. Specialized tools are used to remove the section of bonecalled the bone flap. The bone flap is in the interim removed, then replacedafter the mind surgery has actually been done.

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Some craniotomy procedures might use the accuse of computers and imaging(magnetic resonance imaging or computerized tomography scans) toreach the an accurate location within the brain that is to be treated. Thistechnique requires the usage of a frame placed top top the skull or a framelesssystem making use of superficially inserted markers or landmarks top top the scalp. Wheneither of these imaging measures is used in addition to the craniotomyprocedure, that is referred to as stereotactic craniotomy.

Scans made of the brain, in conjunction with these computers and localizingframes, provide a three-dimensional image, because that example, the a tumor withinthe brain. That is advantageous in do the distinction between tumor organization andhealthy tissue and reaching the precise location of the abnormal tissue.

Other uses include stereotactic biopsy that the brain (a needle is guidedinto an abnormal area so the a item of tissue may be removed for examunder a microscope), stereotactic aspiration (removal of liquid fromabscesses, hematomas, or cysts), and also stereotactic radiosurgery (such asgamma knife radiosurgery).

An endoscopic craniotomy is another type of craniotomy that entails theinsertion of a lighted scope with a camera right into the brain through a smallincision in the skull.

Aneurysm snipping is one more surgical procedure which may require acraniotomy. A cerebral aneurysm (also referred to as an intracranial aneurysm orbrain aneurysm) is a bulging dilute area in the wall of an artery in thebrain, bring about an abnormal widening or ballooning. Because of theweakened area in the artery wall, there is a risk for rupture (bursting) ofthe aneurysm. Placement of a steel clip throughout the "neck" of the aneurysmisolates the aneurysm native the remainder of the circulatory mechanism by blockingblood flow, thereby preventing rupture.

Craniectomy is a comparable procedure during which a section of the skull ispermanently gotten rid of or replaced later throughout a 2nd surgery after theswelling has gone down. .

Other related procedures that might be supplied to diagnose brain disordersincludecerebral arteriogram,computed tomography (CT) scan that the brain,electroencephalogram (EEG),magnetic resonance imaging (MRI) of the brain,positron emissions tomography (PET) scan, andX-rays the the skull. Please check out these measures for extr information.

Our technique to Craniotomy

Johns Hopkins neurosurgeons are very skilled and also experienced in all typesof craniotomy consisting of newer, much less invasive options for brain tumorsurgery, aneurysm surgery and also other procedures. In addition, a specializedclinic offers patients for sure repair of skull deformities after ~ brainsurgery.

Types of Craniotomy

Extended Bifrontal Craniotomy

The prolonged bifrontal craniotomy is a traditional skull base strategy usedto target an overwhelming tumors toward the former of the brain. The is based onthe concept that the is more secure to eliminate extra bone 보다 to unnecessarilymanipulate the brain.

The prolonged bifrontal craniotomy entails making an scratch in the scalpbehind the hairline and also removing the bone that forms the contour of theorbits and also the forehead. This bone is replaced at the finish of surgery.Temporarily removing this bone enables surgeons to work in the an are betweenand ideal behind the eyes without having actually to unnecessarily manipulate thebrain.

The expanded bifrontal craniotomy is generally used because that those tumors thatare no a candidate for removal by minimally invasive approaches because ofeither the anatomy that the tumor, the feasible pathology that the tumor or thegoals the surgery.

Types the tumors treated with the prolonged bifrontal craniotomy includemeningiomas, esthesioneuroblastomas and malignantskull basic tumors.

Minimally Invasive Supra-Orbital “Eyebrow” Craniotomy

Supra-orbital craniotomy (often called "eyebrow" craniotomy) is a procedureused to remove brain tumors. In this procedure, neurosurgeons do a smallincision in ~ the eyebrow to access tumors in the front of the brain or roughly the pituitary gland, i beg your pardon is depths in the mind behind the nose and also eyes. This approach is used rather ofendonasal endoscopic surgerywhen a tumor is very huge or close come the optic nerves or vital arteries.

Because that is a minimally invasive procedure, supra-orbital “eyebrow”craniotomy might offer

less pain than open up craniotomy

faster recovery than open craniotomy

Minimal scar

The supra-orbital craniotomy may be component of the therapy for Rathke’scleft cysts, skull base tumors and also some pituitary tumors.

Retro-Sigmoid “Keyhole” Craniotomy

Retro-sigmoid craniotomy (often dubbed "keyhole" craniotomy) is aminimally-invasive surgical procedure performed to remove mind tumors.This procedure enables for the removed of skull base tumors v a smallincision behind the ear, providing access to the cerebellum and also brainstem.Neurosurgeons might use this method to reach certain tumors, together asmeningiomas, acoustic neuromas (vestibular schwannomas), skull base tumors and metastatic brain tumors.

Benefits of "keyhole" craniotomy has less pains after the procedurethan ~ an open up craniotomy, less scarring and a much more rapid recovery.

Orbitozygomatic Craniotomy

The orbitozygomatic craniotomy is a classic skull base strategy used totarget complicated tumors and also aneurysms. It is based upon the ide that itis safer to remove extra bone 보다 to unnecessarily manipulate the brain.

Typically provided for those lesions that space too complicated for removal by moreminimally invasive approaches, orbitozygomatic craniotomy involves makingan scratch in the scalp behind the hairline and also removing the bone thatforms the edge of the orbit and cheek. This bone is changed at the endof surgery. Temporarily remove this bone allows surgeons to reach deeperand challenging parts that the mind while minimizing severe damage to thebrain.

Brain tumors that may be treated v orbitozygomatic craniotomy includecraniopharyngiomas, pituitary tumors and also meningiomas.

Translabyrinthine Craniotomy

A translabyrinthine craniotomy is a procedure that entails making anincision in the scalp behind the ear, climate removing the mastoid bone andsome of the inside ear bone (specifically, the semicircular canals whichcontain receptors because that balance). The surgeon then finds and removes thetumor, or as much of the tumor as feasible without danger of severe damage tothe brain.

When over there is no beneficial hearing or hear is to it is in sacrificed, the translabyrinthine approach is often considered for removal of acoustic neuromas. During thetranslabyrinthine craniotomy, the semicircular canals that the ear areremoved in bespeak to accessibility the tumor. Finish hearing ns occurs as aresult of the removed of the semicircular canals.

Although listening is shed with the translabyrinthine craniotomy, the hazard offacial nerve injury may be reduced.

Reasons because that the procedure

A craniotomy might be done for a range of reasons, including, however notlimited to, the following:

Diagnosing, removing, or treating brain tumors

snipping or repairing of an aneurysm

removed blood or blood coagulation from a leaking blood vessel

removed an arteriovenous malformation (AVM) or addressing one arteriovenous fistula (AVF)

Draining a mind abscess, i beg your pardon is one infected pus-filled pocket

Repairing skull fractures

Repairing a tear in the membrane lining the brain (dura mater)

Relieving press within the mind (intracranial pressure) by removing damaged or swollen locations of the mind that may be resulted in by traumatic injury or hit

dealing with epilepsy

Implanting stimulator tools to treat movement disorders such together Parkinson"s condition or dystonia (a kind of activity disorder)

There might be various other reasons because that your medical professional to recommend a craniotomy.

Risks of the procedure

As with any type of surgical procedure, complications might occur. Brain surgery riskis tied come the specific location in the mind that the operation willaffect. For example, if the area that the mind that controls decided isoperated on, then speech may be affected. Some an ext general complicationsinclude, but are not minimal to, the following:



Blood clots

Pneumonia (infection that the lungs)

rough blood press


Muscle weakness

brain swelling

Leakage the cerebrospinal liquid (the fluid that surrounds and also cushions the brain)

Risks linked with the usage of general anesthesia

The complying with complications space rare and also generally relate to specificlocations within the brain, so they might or might not be valid dangers forcertain individuals:

Memory problems

Speech challenge


Abnormal balance or coordination


There might be other threats depending ~ above your specific medical condition. Besure to discuss any concerns v your doctor prior to the procedure.

Before the procedure

Your physician will explain the procedure to you and also you deserve to ask questions.

You will be inquiry to authorize a consent form that provides permission to carry out the surgery. Review the form carefully and ask concerns if miscellaneous is no clear.

In addition to a complete medical history, your physician will do a physical exam to for sure you space in an excellent health prior to you experience the surgery. Girlfriend may also need blood tests and other diagnostic tests.

you will receive a preoperative neurological test that will be supplied to compare with postoperative exams.

You will certainly be asked to fast before the procedure, typically after midnight.

If you room pregnant or think you might be, call your health care provider.

phone call your medical professional if you are sensitive to or space allergic to any medicines, latex, tape and also anesthetic agents (local or general).

tell your physician of all drugs (prescribed and also over-the-counter) and herbal supplements the you are taking.

tell your medical professional if you have actually a background of bleeding obstacle or if you room taking any anticoagulant (blood-thinning) medicines, aspirin, or other medications that influence blood clotting. It might be important for girlfriend to stop these medicines prior to the procedure.

If you smoke, you need to stop cigarette smoking as soon as possible before the procedure to improve your opportunities for a effective recovery indigenous surgery and also to improve your in its entirety health status.

You might be asked come wash your hair v a distinct antiseptic shampoo the night prior to the surgery.

You might receive a sedative prior to the procedure to help you relax.

The areas approximately the surgical site will it is in shaved.

based upon your medical condition, her doctor might request other details preparation.


During the procedure

A craniotomy typically requires a hospital stay of 3 to 7 days. Girlfriend mayalso walk to a rehabilitation unit for numerous days after your hospital stay.Procedures may vary relying on your condition and your doctor"spractices.

Generally, a craniotomy complies with this process:

You will be asked to remove any type of clothing, jewelry, or other objects that might interfere with the procedure.

You will be offered a gown to wear.

one intravenous (IV) line will certainly be put in your arm or hand.

A urinary catheter will be placed to drainpipe your urine.

You will certainly be positioned on the operation table in a way that provides the best accessibility to the next of the mind to be operated on.

The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

her head will certainly be shaved and also the skin end the surgical website will it is in cleansed through an antiseptic solution.

There space various types of incisions that may be used, depending on the affected area that the brain. An incision might be made from behind the hairline in prior of her ear and also the nape of your neck, or in one more location relying on the location of the problem. If one endoscope is used, the incisions may be smaller.

your head will certainly be hosted in ar by a an equipment which will be removed at the end of the surgery.

The scalp will be pulled up and clipped to regulate bleeding when providing access to the brain.

A clinical drill might be used to make burr holes in the skull. A one-of-a-kind saw might be offered to very closely cut the bone.

The bone flap will be removed and saved.

The dura mater (the thick outer covering the the brain directly underneath the bone) will certainly be separated from the bone and also carefully cut open to reveal the brain.

Excess liquid will be enabled to circulation out the the brain, if needed. Microsurgical instruments, such as a surgical microscope to magnify the area gift treated, might be used. This can permit the surgeon a much better view that the mind structures and distinguish between abnormal tissue and healthy tissue. Organization samples may be sent out to the lab for testing.

A device, such together a drain or a special form of monitor, might be placed in the brain tissue to measure the pressure inside the skull, or intracranial press (ICP). ICP is pressure developed by the brain tissue, cerebral spinal fluid (CSF), and blood supply within the closed skull.

when the surgical treatment is completed, the surgeon will suture (sew) the layers of tissue together.

The bone flap will be reattached utilizing plates, sutures, or wires.

If a tumor or an epidemic is uncovered in the bone, the flap might not be replaced. Also, if decompression (to alleviate pressure in the brain) is required, the bone flap might not be replaced.

The skin incision (scalp) will be closed through sutures or surgical staples.

A sterile bandage or dressing will be applied over the incision.

After the procedure

In the hospital

Immediately ~ the procedure, you will be required to a restore room forobservation before being required to the intensive care unit (ICU) come beclosely monitored. Or, you may be taken directly to the ICU native theoperating room.

In the ICU, you might be provided medicine come decrease the mind swelling.

Your recovery procedure will vary depending upon the kind of procedure doneand the type of anesthesia given. As soon as your blood pressure, pulse, andbreathing room stable and you are alert, you might be taken to the ICU or yourhospital room.

After continuing to be in the ICU, you will relocate to a room top top a neurosurgicalnursing unit in the hospital. Friend will stay in the hospital because that severalmore days.

You may need oxygen for a period of time after ~ surgery. Generally, theoxygen will certainly be discontinued before you walk home.

You will certainly be teach deep-breathing practice to aid re-expand the lung andprevent pneumonia.

Frequent neurological checks will be excellent by the nursing and medical staffto check your mind function and also to make certain your body equipment arefunctioning appropriately after your surgery. You will be asked to follow avariety of an easy commands, together as relocating your arms and also legs, to assessyour mind function. Her pupils will be checked through a speed light, andyou will be asked concerns to assess your orientation (such as your name,the date, and also where you are). The stamin of your arms and also legs will certainly alsobe tested.

The head of her bed may be elevated to protect against swelling the your challenge andhead. Part swelling is normal.

You will certainly be urged to move approximately as tolerated while in bed and to getout the bed and walk around, with assistance at first, together your strengthimproves. A physical therapist (PT) might be asked come evaluate her strength,balance, and mobility, and give you proposal for practice to execute both inthe hospital and also at home.

You will certainly likely have sequential compression gadgets (SCDs) placed on yourlegs if you room in bed to stop blood clot formation. SCDs have an aircompressor that progressively pumps air into and also out of fitted sleeves the areplaced on the legs. They help prevent blood coagulation from creating by passivelycompressing the leg veins to store blood moving.

Depending on her situation, you may be offered liquids to drink a couple of hoursafter surgery. Her diet may be gradually readjusted to include an ext solidfoods together you have the right to handle them.

You may have a catheter in her bladder to drainpipe your urine because that a day orso, or till you space able to get out the bed and move around. Be certain toreport any painful urination or other urinary symptom that happen after thecatheter is removed, as these might be signs of an infection that have the right to betreated.

Depending on her status, you might be moved to a rehabilitationfacility for a period of time to regain your strength.

Before you space discharged indigenous the hospital, arrangements will be do fora follow-up visit with your doctor. Your physician will also give youinstructions for house care.

At home

Once you are home, it is necessary to store the scratch clean and also dry. Yourdoctor will give you particular bathing instructions. If darn or surgicalstaples space used, they will certainly be removed during a follow-up office visit. Ifadhesive strips are used, keep them dry and they will fall off in ~ a fewdays.

You may choose to wear a loose turban or cap over the incision. You shouldnot stay a wig until the incision is completely healed (about 3 to 4 weeksafter surgery).

The incision and head may ache, specifically with deep breathing, coughing,and exertion. Take a pains reliever for soreness together recommended by yourdoctor. Aspirin or other blood thinning medicines may rise the chanceof bleeding. Be certain to take just recommended medicines and ask if friend areunsure.

Continue the breath exercises used in the hospital to avoid lunginfection. You will certainly be recommend to prevent exposure to upper respiratoryinfections (colds and flu) and also irritants, such together tobacco smoke, fumes, andenvironmental pollution.

You should gradually increase her physical task as you have the right to handlethem. It may take numerous weeks to return to your vault level that energyand strength.

You might be instructed to stop lifting heavy items for several weeks toprevent strain on your surgical incision.

Do not drive till your doctor offers you permission.

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Call your medical professional to report any type of of the following:

fever or cold storage

Redness, swelling, drainage, or bleeding or other drainage from the incision website or confront

enhanced pain around the incision site

Vision transforms

confusion or too much sleepiness

weak of your arms or legs

Trouble through speech

trouble breathing, chest pain, anxiety, or adjust in psychological status

Green, yellow, or blood-tinged sputum (phlegm)

Seizure task

Following a craniotomy, your medical professional may offer you other instructions,depending ~ above your particular situation.