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Craniotomy
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Craniotomy

Pronounced: Crane-knee-ah-toe-me

En Español (Spanish Version)

Definition

A craniotomy is a surgery done on the head. The surgeon cuts through the skull to reach the brain. There are different types of craniotomies, including:

  • Burr hole—A small hole is made in the skull.
  • Traditional craniotomy—A piece of skull is cut out and then put back after the surgery.
  • Stereotaxy—A computer is used to help find where things are in the brain during the surgery.
  • Awake craniotomy—The patient is awake during part of the surgery.

Craniotomy

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© 2011 Nucleus Medical Media, Inc.

Reasons for Procedure

The success of this surgery depends on the reason for the surgery. The most common reasons for a craniotomy include:

  • Biopsy —to obtain a brain tissue sample
  • Brain cancer
  • Head trauma
  • Blood clot in the brain
  • Blood vessel problems with the brain
  • Nerve disorders
  • Brain swelling
  • Brain infection

Factors that may increase the risk of complications include:

Possible Complications

If you are planning to have a craniotomy, your doctor will review a list of possible complications which may include:

  • Bleeding
  • Infection
  • Brain swelling
  • Damage to your brain which may cause:
    • Changes in memory, behavior, thinking, or speech
    • Vision problems
    • Problems with balance
    • Bowel and bladder problems
    • Seizures
    • Paralysis or weakness
  • Reaction to anesthesia (eg, light-headedness, low blood pressure, wheezing)
  • Heart attack
  • Blood clots

What to Expect

Prior to Procedure

If your surgery is planned, your doctor will review the surgery and what to expect afterwards. At your appointment before your surgery, your doctor may:

  • Perform an exam to check how your nerves and brain work
  • Order an MRI scan , CT scan , or PET scan of the brain
  • Ask questions like:
    • What kind of help will you have at home?
    • Do you have any new symptoms?

Be sure to ask your doctor any questions that you have, such as:

  • What will my recovery be like?
  • Will I need rehabilitation after surgery?
  • When will I be able to return to work?

Other things to remember:

  • Talk to your doctor about your medicines. Your doctor may ask you to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners like clopidogrel (Plavix) or warfarin (Coumadin)
  • Arrange for a ride home from the hospital.
  • Arrange for help at home while you recover.
  • You will be asked to fast for 8-12 hours before your surgery. Because of this, ask your doctor if you should take your regular medicines with a sip of water before your surgery.

Anesthesia

General anesthesia is used for most craniotomies. General anesthesia will block any pain and keep you asleep during the surgery. It is given through an IV (needle) in your hand or arm.

If you have an awake craniotomy , you will be given general anesthesia. You will be awake for part of the surgery.

If you have stereotaxy surgery , you may be given local anesthesia. This blocks just the area where surgery will happen.

Description of Procedure

Once you are asleep and no longer feeling any pain, a breathing tube will be placed. Your head will be shaved and your skin washed with an antiseptic. The surgeon will cut into part of your scalp. Next, part of your skull will be removed and your brain covering will be opened. Depending on the reason for your surgery, several things may happen: a tumor may be removed, a part of your brain tissue may be taken (biopsy), a tube may be placed, or repairs to your brain or its vessels may be done. The brain opening will then be sewn back into place and your skull replaced. Staples or stitches will be used to close the cut. A drain may be inserted to remove blood and fluid for the first few days after surgery. A dressing will be wrapped around your head.

Immediately After Procedure

After your surgery, you will be taken to the recovery room for observation. If all is well, your breathing tube will likely be removed. Your mental status and vital signs (temperature, heart rate, blood pressure, and respirations) will be checked often. After being in the recovery room, you may spend some time in the intensive care unit (ICU) or step-down unit, before being moved to a hospital room. This will depend on the reason for your surgery.

How Long Will It Take?

Several hours (depending on the type and reason for surgery)

How Much Will It Hurt?

During surgery, you will feel no pain. After surgery, you will be given pain medicine to manage any pain.

Average Hospital Stay

3-7 days (Your doctor may keep you longer if complications arise.)

Post-procedure Care

At the Hospital

  • To reduce the risk of brain pressure build-up:
    • You may receive steroids and other medicines to keep your body fluid level low.
    • The head of your bed will be raised.
    • Fluids given to you may be limited.
    • You may be given medicines to prevent vomiting.
    • Do not strain or hold your breath unless your healthcare staff says it is okay.
  • Your mental status will be checked often.
  • You may receive medicine to prevent seizures.
  • You may receive antibiotics to prevent infection.
  • Your dressing will be removed 24-48 hours after surgery and be replaced with lighter dressing.
  • You may have a drain inserted after surgery. In most cases, it will be removed in the hospital.
  • You may be asked to get out of bed and walk around to prevent complications like blood clots or pneumonia .

At Home

When you return home, do the following to help ensure a smooth recovery:

  • Get some help from family and/or friends as you recover.
  • Keep your cut clean and dry. Check it for redness, swelling, drainage, or separation of the edges.
  • Do physical therapy, occupational therapy, and/or speech therapy if ordered by your doctor. Therapists may come to your home, or you may see them in their office.
  • Get enough rest and eat a healthy diet to help your body recover.
  • If you feel depressed , talk to a therapist, psychologist, or other counselor.
  • Be sure to follow your doctor's instructions .

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Any changes in physical ability (balance, strength, or movement)
  • Any changes in mental status (level of consciousness, memory, thinking, or responsiveness)
  • Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the cut
  • Headache that does not go away
  • Stiff neck
  • Changes in vision (like double, blurred, or vision loss)
  • Fainting or seizures
  • Numbness, tingling, or weakness in your face, arms, or legs
  • Signs of infection, including fever and chills
  • Nausea and/or vomiting that you can't control with the medicines you were given after surgery or which continue for more than two days after leaving the hospital
  • Pain that you can't control with the medicines you've been given
  • Difficulty breathing
  • Cough , shortness of breath, or chest pain
  • Trouble controlling your bladder and/or bowels
  • Swelling, tenderness, hotness, or redness anywhere in your legs

In case of an emergency, CALL 911 .

RESOURCES:

American Brain Tumor Association
http://www.abta.org/

National Brain Tumor Foundation
http://www.braintumor.org/

CANADIAN RESOURCES:

Brain Tumor Foundation of Canada
http://www.braintumour.ca/braintumour.nsf/eng/home

Canadian Cancer Society
http://www.cancer.ca/

References:

The essential guide to brain tumors. National Brain Tumor Foundation website. Available at: http://www.braintumor.org/upload/contents/330/GuideFINAL2007.pdf . Accessed September 15, 2009.

Guide to the care of the patient with craniotomy post-brain tumor resection. American Association of Neurological Nurses website. Available at: http://www.aann.org/pubs/cpg/craniotomy.pdf . Accessed September 15, 2009.

Polsdorfer R. Surgical procedures for brain tumors. EBSCO Health Library. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15&topicID=81 . Last reviewed February 2009. Updated April 4, 2009. Accessed September 15, 2009.

Professional Guide to Diseases . 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.

White-Guthro M. Craniotomy. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/dynamed/. Published April 3, 2009. Accessed September 15, 2009.

6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.



Last reviewed September 2010 by Marcin Chwistek, MD


Last updated Updated: 6/3/2011

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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