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Craniotomy
Craniotomy
Overview
Craniotomy is a cut that opens the cranium. During
this surgical procedure, a section of the skull, called
a bone flap, is removed to access the brain
underneath. The bone flap is usually replaced after
the procedure with tiny plates and screws.
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What happens before surgery? Special tools & techniques
You will typically undergo tests (e.g., blood test,
electrocardiogram, chest X-ray) several days before Broadly termed image-guided surgery (IGS),
surgery. In the doctors office you will sign consent stereotactic techniques help the neurosurgeon
forms and complete paperwork to inform the pinpoint the exact location of a lesion within
surgeon about medical history (i.e., allergies, normal tissue.
medicines, anesthesia reactions, previous surger-
ies). You may wish to donate blood several weeks Stereotactic means to locate a structure by
before surgery. Discontinue all non-steroidal anti- use of 3-dimensional coordinates.
inflammatory medicines (Naproxin, Advil, etc.) and
blood thinners (coumadin, aspirin, etc.) 1 week Frame-based stereotaxy uses a lightweight
before surgery. Additionally, stop smoking, chewing stereotactic head frame attached to the
tobacco, and drinking alcohol 1 week before and 2 patient’s skull. CT or MRI scans are taken. The
weeks after surgery because these activities can stereotactic frame shows up on the scan and
cause bleeding problems. helps pinpoint the exact location of the lesion.
The frame serves as a reference point to
What happens during surgery? precisely guide instruments through a burr
There are 6 main steps during a craniotomy. hole.
Depending on the underlying problem being treated
and complexity, the procedure can take 3 to 5 Frameless stereotaxy uses tiny markers,
hours or longer. called fiducials, instead of a head frame. MRI
or CT scans are taken and used to create a 3D
Step 1: prepare the patient computer model. During surgery, the fiducials
No food or drink is permitted past midnight the and infrared cameras correlate the “real
night before surgery. Patients are admitted to the patient” to the 3D computer model and
hospital the morning of the craniotomy. With an function as a global positioning system to help
intravenous (IV) line placed in your arm, general plan the craniotomy and locate the lesion.
anesthesia is administered while you lie on the Instruments are detected by the cameras and
operating table. Once asleep, your head is placed in displayed on the computer model.
a 3-pin skull fixation device, which attaches to the
table and holds your head in position during the Intraoperative MRI or CT is a specially
procedure (Fig. 2). designed operating room in which the patient
can undergo an MRI or CT scan before, during,
Insertion of a lumbar drain in your lower back helps and after surgery. This enables the surgeon to
to remove cerebrospinal fluid (CSF), thus allowing have real-time images of the patient’s brain
the brain to relax during surgery. A brain-relaxing and to know exactly how much tumor has
drug called mannitol may be given. been removed prior to ending the procedure.
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called loupes, or an operating microscope to see the
delicate nerves and vessels.
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Discharge instructions When to Call Your Doctor
Discomfort 10. If you experience any of the following:
1. After surgery, headache pain is managed with • A temperature that exceeds 101º F
narcotic medication. Because narcotic pain pills • An incision that shows signs of infection,
are addictive, they are used for a limited period such as redness, swelling, pain, or
(2 to 4 weeks). Their regular use may also drainage.
cause constipation, so drink lots of water and • If you are taking an anticonvulsant, and
eat high fiber foods. Laxatives (e.g., Dulcolax, notice drowsiness, balance problems, or
Senokot, Milk of Magnesia) may be bought rashes.
without a prescription. Thereafter, pain is • Decreased alertness, increased drowsiness,
managed with acetaminophen (e.g., Tylenol) weakness of arms or legs, increased
and nonsteroidal anti-inflammatory drugs headaches, vomiting, or severe neck pain
(NSAIDs) (e.g., aspirin; ibuprofen, Advil, that prevents lowering your chin toward the
Motrin, Nuprin; naproxen sodium, Aleve). chest.
2. A medicine (anticonvulsant) may be prescribed
temporarily to prevent seizures. Common Recovery
anticonvulsants include Dilantin (phenytoin), The recovery time varies from 1 to 4 weeks
Tegretol (carbamazepine), and Neurontin depending on the underlying disease being treated
(gabapentin). Some patients develop side and your general health. Full recovery may take up
effects (e.g., drowsiness, balance problems, to 8 weeks. Walking is a good way to begin
rashes) caused by these anticonvulsants; in increasing your activity level. Start with short,
these cases, blood samples are taken to frequent walks within the house and gradually try
monitor the drug levels and manage the side walks outside. It’s important not to overdo it,
effects. especially if you are continuing treatment with
radiation or chemotherapy. Ask your surgeon when
Restrictions you can expect to return to work.
1. Do not drive after surgery until discussed with
your surgeon and avoid sitting for long periods
What are the risks?
of time.
No surgery is without risks. General complications
2. Do not lift anything heavier than 5 pounds
of any surgery include bleeding, infection, blood
(e.g., 2-liter bottle of soda), including children.
clots, and reactions to anesthesia. Specific
3. Housework and yard-work are not permitted
complications related to a craniotomy may include:
until the first follow-up office visit. This includes
• stroke
gardening, mowing, vacuuming, ironing, and
• seizures
loading/unloading the dishwasher, washer, or
• swelling of the brain, which may require a
dryer.
second craniotomy
4. Do not drink alcoholic beverages.
• nerve damage, which may cause muscle
paralysis or weakness
Activity
• CSF leak, which may require repair
5. Gradually return to your normal activities.
• loss of mental functions
Fatigue is common.
• permanent brain damage with associated
6. An early exercise program to gently stretch the
disabilities
neck and back may be advised.
7. Walking is encouraged; start with short walks
and gradually increase the distance. Wait to What are the results?
participate in other forms of exercise until The results of your craniotomy depend on the
discussed with your surgeon. underlying condition being treated.
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Glossary image-guided surgery: use of preoperative CT
biopsy: a sample of tissue cells for examination or MRI scans and a computer workstation to guide
under a microscope to determine the existence or surgery.
cause of a disease. otologic surgeon: a doctor who specializes in
burr hole: a small dime-sized hole made in the surgery of the ear.
skull. oculoplastic surgeon: a doctor who specializes
cerebrospinal fluid (CSF): a clear fluid produced in surgery of the eye and face.
by the choroid plexus in the ventricles of the brain skull base surgeon: a doctor with special training
that bathes the brain and spinal cord giving them to perform complex craniotomies at the base of the
support and buoyancy to protect from injury. skull.
craniectomy: surgical removal of a portion of the seizure: uncontrollable convulsion, spasm, or
skull. series of jerking movements of the face, trunk,
craniotome: a special saw with a footplate that arms, or legs.
allows cutting of the skull without cutting the dura shunt: a drainage tube to move cerebrospinal fluid
mater. from inside the ventricles of the brain into another
craniotomy: surgical opening of a portion of the body cavity (e.g., abdomen).
skull to gain access to the intracranial structures stroke: a condition caused by interruption of the
and replacement of the bone flap. blood supply to the brain; may cause loss of ability
dura mater: the outer protective covering of the to speak or to move parts of the body.
brain. stereotactic: a precise method for locating deep
endoscopic-assisted surgery: a procedure using brain structures by the use of 3-dimensional
a probe (endoscope) fitted with a tiny camera and coordinates.
light, which is inserted through a small keyhole ultrasonic aspirator: a surgical tool that uses
craniotomy to remove a tumor. a fine jet of water, ultrasonic vibration, and suction
laser: a device that emits a narrow intense beam to break up and remove lesions.
of energy to shrink and cut tissue.
lesion: a general term that refers to any change in
tissue, such as tumor, blood, malformation,
infection, or scar tissue.
Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic & Spine Institute. We comply with the HONcode standard for
trustworthy health information. This information is not intended to replace the medical advice of your health care provider. © Mayfield Clinic 1998-2013.
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