Craniotomy
All content is checked by medical journalists.The craniotomy is the operative opening of the bony skull. It is performed by the neurosurgeon as an access route for operations on the brain. Read everything about the process of the craniotomy, when it is necessary and what the risks are.
What is a craniotomy?
A craniotomy is the surgical opening of the bony skull. It serves as an access route for operations on the brain and its neighboring structures. As part of the craniotomy, a bone plate is lifted out of the skull so that a round hole is created in the top of the skull.
There are two methods of closing the hole: osteoclastic craniotomy and osteoplastic craniotomy. In an osteoclastic craniotomy, the surgeon does not put the cut piece of bone back into its original position; the hole is only closed with the rind and scalp. This method is used, for example, with increased intracranial pressure. In the osteoplastic craniotomy, the doctor reinserts the bone plate into the roof of the skull, where it grows together with the surrounding bone after a few months.
The craniotomy is classified according to the location of the removed skull plate:
- Frontal craniotomy (anterior temporal region)
- Temporal craniotomy (posterior temple region)
- Pterional craniotomy (anterior temporal region)
- Parietal craniotomy (vertex region)
- Occipital craniotomy (back of the head)
- Suboccipital craniotomy (region below the occiput)
When to do a craniotomy
Almost all neurosurgical operations on the brain or on the meninges require the skull to be opened. Craniotomy can be used in the surgical treatment of the following diseases:
- Brain tumors
- Cerebral hemorrhage
- Increased intracranial pressure (relief craniotomy)
- Obtaining tissue samples
- Outsourcing of cerebral arteries (aneurysms)
- Areas of the brain that cause epilepsy
- Brain abscess
What do you do with a craniotomy?
The human skull is divided into the brain skull and the facial skull. While the facial skull consists of 15 bones, such as the nasal bone and the cheek and jaw bones, the brain skull forms a protective cavity for the brain. It consists of the top of the skull and the base of the skull. The inside of the skull is lined with the "hard meninges".
Before the operation
Before most procedures, the patient is put to sleep and feels no pain. But there are also neurosurgical operations that require the patient to be awake - for example, when the doctor is performing neurological tests during the procedure. He needs the active cooperation of the patient and can thus localize certain brain regions, such as the language center. These surgical methods are of course also painless.
In order to stabilize the head during the operation, it is usually fixed with a frame (so-called Mayfield clamp). Now the scalp hair is shaved at the surgical site and the patient's scalp is disinfected and covered.
During the operation
Using a scalpel, the surgeon carefully loosens the scalp and scalp from the bone over the diseased area of the brain and folds them to one side. The skull bone is now exposed. The doctor uses a bone saw to cut a bone plate out of the skull. The size of the plate depends on the actual disease.
Now the surgeon has free access to the brain and can perform the operation, for example removing a tumor. When the procedure is over, the surgeon closes the opening in the top of the skull again. If he chooses the "osteoclastic craniotomy" for this, the bone plate is not put back into the roof of the skull. Instead, the doctor sutures the meninges, scalp and scalp over the opening.
In the "osteoplastic craniotomy", the bone cover is put back into the roof of the skull after protruding edges or loose pieces of bone have been carefully ground off beforehand. Here, too, the doctor sutures the meninges, the scalp and the scalp over the wound.
After the operation
After a craniotomy, the patient is monitored in the intensive care unit, as there is a risk of rebleeding or brain swelling immediately after the operation. To do this, the anesthetist in the intensive care unit checks breathing, cardiovascular values and neurological functions. As a rule, the patient can return to the normal ward as early as 24 hours after the craniotomy.
What are the risks of a craniotomy?
As with any surgical procedure, complications can arise in individual cases.Possible risks are:
- Bleeding and bruising, possibly with surgical removal
- Blood clot formation
- infection
- Wound healing disorder
- Cosmetically unsatisfactory scarring
- Incidents of anesthesia
The individual surgical risks depend on the patient's underlying disease and the operation itself, i.e. the area of the brain that was operated on.
Particular risks of opening the skull and surgery on the brain can be:
- Injury to healthy brain tissue
- Seizure disorders
- Leakage of cerebral fluid (liquor)
- Memory problems
- Coordination or balance disorders
- Paralysis
- Difficulty speaking
- Accumulation of air in the cranial cavity (pneumocephalus)
- coma
Some of these complications, such as seizures, may also occur some time after surgery because they are caused by scarring in the brain.
What do I have to consider after a craniotomy?
The bandage is usually opened on the third day after the procedure. The staples or sutures used to close the surgical wound are usually removed ten days after the operation. Avoid scratching the wound while grooming your hair, and keep it dry. You should wash your hair 48 hours after the staples or stitches have been removed. The hair can only be colored after three to four weeks.
As epileptic seizures can occur after a craniotomy, you are considered unfit to drive and may not drive again until three months after the operation.
Whether and when you can exercise after a craniotomy depends on the underlying disease and the healing process. In principle, you should avoid heavy physical exertion; light sporting activities are allowed.
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