What are Craniotomy and Craniectomy?

Craniotomy and craniectomy are surgical procedures used to access the brain and treat tumors, intracranial pressure, or other conditions. These surgeries are performed by creating holes in the skull, or cranium, to expose the brain. The opening in the skull can be immediately replaced (craniotomy), or it can be replaced during a later procedure (craniectomy). The following procedures use craniotomy or craniectomy:

  • Brain biopsy, which is done by guiding a needle through the opening in the skull to the targeted area of the brain. This procedure may be performed through an open or minimally invasive approach. The minimally invasive approach, called stereotactic brain biopsy, uses a computer to guide the needle.
  • Brain tumor resection, which may be performed following a biopsy with image guidance. Depending on the size and location of the tumor, resection will require 2-5 hours.
  • Cerebrospinal fluid (CSF) leak repair, particularly for leaks that continue for a long period of time after a surgery. CSF leaks that are left untreated can lead to complications such as meningitis, an inflammation of the outer layers (meninges) of the brain.
  • Decompression, often following a stroke or injury. Decompressive craniotomy or craniectomy temporarily removes a flap from the skull to give the brain more room for swelling, which provides pressure relief.
  • Hematoma evacuation, which can also relieve pressure on the brain. A hematoma is a swelling of clotted blood. It can occur between the skull and the outer covering of the brain, or dura (epidural), between the dura and the brain (subdural), and within the brain (intracerebral). Craniotomy or craniectomy may be used to access and remove the hematoma.

To perform a craniotomy, your surgeon will need to make an incision on your scalp to expose your skull. Some of your hair may be shaved, and your scalp will be cleaned with antiseptic solution. Following the incision, your surgeon will use a drill to remove a piece of your skull, called a bone or skull flap. If your surgeon needs to reach a tumor or perform an aspiration, the dura, which covers the brain, will be incised (cut) to access the lesion. The bone flap will be reattached once your surgeon has completed the procedure. If your surgeon is performing a craniectomy, the same steps will be followed, but a mesh piece will be placed where the bone flap was, and your scalp will be surgically closed. You will need to wear a special helmet for a few months after your procedure. The bone flap will be preserved and replaced during a later operation, or it may never be replaced.

Your recovery period can range from two days to two weeks, depending on the specific procedure and condition. You will require monitoring and may be given medication for pain or brain swelling. You will have to restrict your physical activity for some time after your procedure, and you may need to work with a physical therapist.

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