The skull is actually not a single bone. It consists of several facial bones that protect your face and cranial bones that protect your brain. And although the top of your head might feel smooth, those eight cranial bones are fused together by sutures, which are special joints made of thick connective tissue. Because the cranial bones cannot be easily separated, in order for a surgeon to access anything on the other side of these bones to begin treatment on a condition affecting the brain or related areas, a surgeon will use special tools to remove a piece of the skull, called a bone flap. This procedure, which is usually the first step when you have brain surgery, is called a craniotomy.
A craniotomy may sometimes have a more descriptive name (such as keyhole craniotomy, eyebrow craniotomy, or extended bifrontal craniotomy) based on the size and location of the bone flap.
Conditions Requiring a Craniotomy
There are several reasons you may undergo a craniotomy, including:
- Brain tumors (diagnosing, removing, or treating)
- Traumatic brain injury or skull fracture
- Bleeding (hemorrhage or hematoma) or blood clots
- Aneurysms (clipping or repairing)
- Epilepsy or seizures
- Nerve or facial pain
- Swelling that causes pressure on the brain
- Arteriovenous malformation (AVM), an abnormal mass of blood vessels
- Disorders affecting movement, such as Parkinson’s disease
Preparing for Your Craniotomy
Your surgeon will help you understand how to prepare ahead of time for your surgery, which will include the craniotomy and the procedure to be performed after the bone flap is removed. You will be instructed on:
- The potential risks of the surgery
- Any tests you need to take beforehand
- Diet and cleaning the night before and day of your surgery
- Which of your current medications you need to stop taking
At the time of your surgery, you will be prepped as you would be for any surgical procedure, such as wearing a gown, and you will have an intravenous (IV) line inserted in your arm or hand to supply liquids or medicine, as well as a urinary catheter inserted to drain your urine.
The Craniotomy Procedure
A strip of hair along the incision will be shaved and you will receive general anesthesia so you won’t be awake during the procedure. Once you’re in the operating room, your head will be secured by a device to prevent it from moving. Before the skull can be opened, incisions will be made to the skin and muscles in the area so they can be pulled back, exposing the skull.
Small holes called burr holes will likely be drilled to form an outline—almost like a “connect the dots” drawing—for the bone flap. The surgeon then uses a drill to cut between the dots and remove the flap. In some cases, your procedure can be performed through the burr holes with an endoscope, a thin tube with a light and camera.
After removing the bone flap, the surgeon will open a thick outer covering under the flap, called the dura, and fold it back and secure it so the brain can be accessed in order to perform the rest of the surgery.
When the surgery is complete, the dura is closed with sutures and the bone flap is replaced and secured with plates and screws that are permanent in order to support the area. You might receive a drain under the skin to remove fluids or blood for a couple of days.
If your condition involves a swelling of the brain, the bone flap might not be replaced right away; in fact, it could be days or weeks, during which your bone flap will be placed in a sterile environment and you may wear a protective helmet to prevent injury or contamination to the area. In this case, the procedure is called a craniectomy. The need for a craniectomy more often occurs in the setting of trauma or other emergency neurosurgical procedures, and is less common in elective procedures for tumor removal, etc.
After your bone flap is replaced and secured, the muscles and skin will be re-approximated and closed with a combination of sutures and skin clips. Antibiotic ointment is typically applied to the wound.
Once you leave the operating room, you will be moved to a recovery room, where you will be monitored for complications before transferring to a regular room or an intensive care unit (ICU), depending on the nature of your condition and state of your recovery—both from the anesthesia and the procedure.
Throughout your recovery in the hospital, you will receive neurological checks to make sure your brain is functioning properly. These may include wiggling your toes or moving your arms and legs, or answering simple questions about yourself, the date, or where you are.
Your hospital stay may last as few as one day or up to a week or longer, and you may require physical therapy. Again, this depends on a number of factors, including your age, the reason for the craniotomy, and how well you’re recovering.
You will receive specific discharge instructions related to your recovery at home. General restrictions for at least the first two weeks include refraining from lifting anything heavier than five pounds, avoiding strenuous activities, and avoiding alcohol and nicotine products.
Your at-home instructions will include how to keep the area where the surgeon operated clean and dry, as well as recommendations for resuming activities, gradual exercise, your medications, and when to call your doctor prior to your follow-up appointment, which usually occurs within two weeks after surgery.
Full recovery could take up to two months. Speak to your doctor about recovery times related to your specific condition.
Contact M. Neil Woodall, MD, Today
Your brain surgery requires skill not just for your neurological procedure, but to perform the craniotomy that is required to access the area that needs treatment. By trusting in Dr. Woodall’s training and experience, you can feel confident and secure when you have a condition that requires this delicate technique. Contact our office today.