Surgical Procedures: Craniotomy
What is a craniotomy and how is it performed?
The skull is composed of 22 bones and is responsible for protection of the brain, as well as supporting cranial soft tissue. A craniotomy is a surgical procedure that is done to open a portion of the skull to access the brain.
A craniotomy may be recommended in cases of certain medical conditions including brain tumors and/or the need to obtain a brain biopsy. It may also be recommended in non-cancerous, or benign conditions like head trauma, aneurysm repair, blood clots, abnormalities in blood vessels, conditions involving the nerves, brain swelling or infection, repair of a torn dura mater (brain lining) and in cases of hydrocephalus, epilepsy, and arteriovenous malformation (AVM). Additionally, a craniotomy may be recommended to treat Parkinson’s disease or dystonia with an internal stimulator device.
There are several different types of craniotomy, including:
- Endoscopic craniotomy: During this procedure, a surgical tool using a lighted scope and camera is used. It is inserted into the skull through a small surgical incision.
- Stereotactic craniotomy: During this procedure, a CT scan or MRI is used to accurately determine the area of the brain requiring treatment and finding areas of health versus abnormal tissue.
- Extended Bifrontal Craniotomy: During this procedure, surgeons will make an incision behind the hairline, temporarily removing the bone forming the orbital and forehead shape.
- Minimally Invasive Supra-Orbital “Eyebrow” Craniotomy: During this procedure, access to the brain is obtained by a small incision within the eyebrow. The potential benefits to this method include less pain, faster recovery and minimal post-operative scarring.
- Retro-Sigmoid “Keyhole” Craniotomy: During this procedure, access to the base of the skull through a small incision made behind the ear. The potential benefits to this method include less pain, faster recovery and reduced post-operative scarring.
- Orbitozygomatic Craniotomy: During this procedure an attempt to minimize brain damage is made by temporarily removing the bone which contours the cheek and the orbit (eye socket) allowing for better access to the brain.
- Translabyrinthine Craniotomy: During this procedure, which typically will result in permanent hearing loss, access to the brain is obtained through an incision made behind the ear, with removal of bones including the mastoid bone and inner ear bones.
- Crainectomy: During this procedure, a portion of the skull will be permanently removed.
What are the risks associated with craniotomy?
As with any surgical procedure, there are risks and side effects associated with undergoing a craniotomy. Risks and side effects associated with craniotomy vary depending on the location within the brain being operated on, but may include:
- Risks associated with general anesthesia, including reaction to the medication
- Blood clots
- Blood pressure instability
- Swelling of the brain
- Heart attack
- Muscle weakness and/or paralysis
- Cerebrospinal fluid leak
- Memory, balance, vision, hearing, bowel and bladder or speech deficits/difficulties
What is recovery like?
Recovery from a craniotomy will depend on the extent of the procedure performed. Typically, a 3-7 day hospital stay is required. A temporary urinary catheter may be draining your urine temporarily after the surgery.
You will be instructed on how to care for your surgical incisions and will be given any other instructions prior to leaving the hospital.
Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, constipation, seizure prevention and/or other conditions.
Although your healthcare provider will discuss your particular activity restrictions, generally it is advised that you:
- Follow your healthcare provider’s specific incision care instructions. Be sure to keep the surgical incision clean and dry.
- Bathe as directed by your healthcare team. You may be asked to wash your hair daily.
- Avoid tub bathing, swimming or other activities which would submerge your surgical incision for 4 weeks or until advised by your healthcare team.
- Avoid wigs until about 3 to 4 weeks post-operatively, as it will take time for your surgical incision to fully heal; a loose turban or hat is typically fine to wear.
- Take pain medications as directed; speak with your healthcare team before taking aspirin, ibuprofen other blood thinning medications.
- Avoid dying your hair or getting a perm for 4 weeks post operatively.
- Avoid putting topical medications/skin products on the surgical incision unless your healthcare team advises you to do so.
- Avoid being exposed to people who have the cold, flu or other respiratory infections.
- Avoid exposure to second hand smoke, fumes and environmental pollution.
- Avoid heavy lifting, pushing or pulling; following surgery do not lift, push or pull anything more than 10 lb for 4 weeks.
- Advance your physical activity gradually and seek the advice of your healthcare team; rigorous activity and regular exercise should be avoided for 4 weeks. Do not perform any activities which would pose a risk for head trauma, like skiing, contact sports, etc, for 8 weeks or until advised by your healthcare team.
- Typically you can return to work within 4-6 weeks depending on your particular situation.
- Your healthcare team will discuss with you when it is safe to drive as there are many factors in determining road safety. Typically, you can resume driving 1 week post-operatively if you are not taking narcotics, never had a seizure and are free from any neurological deficits. Those who have had a pre or post-operative seizure, should not resume driving for 90 days and when seizures are controlled.
What will I need at home?
- Thermometer to check for infection
- Wound/Incision care supplies
When to call your doctor
Contact your healthcare team with any of the following symptoms:
- Fever of >101 degrees F
- Unrelieved pain
- Incisional redness, swelling, drainage or bleeding
- Phlegm that is green, yellow or blood-tinged
- Persistent headaches
- Stiff neck
- Behavioral changes and/or mental status changes, confusion and/or depression
- Drowsiness, fainting and/or seizures
- Vision changes
- Balance, strength or movement changes
- Facial, arm or leg numbness, tingling and/or weakness
- Persistent nausea/vomiting and/or the inability to keep down food or drink
- Bowel and/or bladder changes including the inability to urinate or have a bowel movement and/or the inability to control your bowel and/or bladder
- Coughing, shortness of breath, problems breathing and/or chest pain
- Leg swelling, tenderness, redness or warmth
How Can I Care for Myself?
Depending on the extent of your surgery, you may need a family member or friend to help you with your daily tasks until you are feeling better and your medical team gives you the go ahead to resume normal activity.
Be sure to take your medications as directed to prevent pain, infection and/or constipation and call your medical team with any concerning symptoms.
If you experience constipation, diet modifications, increased fluid intake, and over-the-counter medication, such as docusate sodium or Milk of Magnesia may be helpful to relieve constipation. To avoid straining to have a bowl movement, consider an enema or rectal suppository if oral stool softeners are ineffective. Speak with your healthcare team for additional recommendations.
Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.
- A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
- Find more relaxation exercises on OncoLink.
This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.
Skull. Retrieved from http://www.innerbody.com/image_skelbov/skel06_new_bov.html on June 16, 2016
John’s Hopkins Medicine. Craniotomy. Retrieved from http://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/craniotomy_92,p08767/ on June 16, 2016
Mount Sinai Hospital. Craniotomy. (December 2014) Retrieved from http://www.mountsinai.org/patient-care/health-library/treatments-and-procedures/craniotomy on June 16, 2016
UC Denver. Post-operative Instructions After a Craniotomy. Retrieved from http://www.ucdenver.edu/academics/colleges/medicalschool/departments/Neurosurgery/patientcare/multi-disciplinaryprograms/AdultBrainTumorProgram/Documents/Post-Op%20instructions%20crani%20for%20brain%20tumor.pdf on June 16, 2016
Craniotomy. Retrieved from https://www.aurorahealthcare.org/services/neuroscience/services-treatments/neurosurgery/craniotomy#Overview on June 16, 2016