Craniotomy

A craniotomy is a type of brain surgery where a surgeon removes a section of your skull (bone flap). This opening lets your surgeon reach your brain to treat tumors, blood vessel issues, infections or injuries.

You won’t feel any pain during this procedure, as you’ll receive anesthesia. Surgeons use special tools to make the opening, treat the issue and then put the bone flap back in place. They usually secure it with small plates and screws.

A craniotomy is common and often safe, but it carries risks. Your care team will discuss the risks and how they work to lower them.

Recovery takes time. Your provider will guide you on rest, activity and follow-up care after the procedure.

What does a craniotomy treat?

This procedure may treat the following conditions:

• Brain bleed
• Brain infections (like abscesses)
• Brain tumors (like meningioma, glioma or cancer that has spread to your brain)
• Head or skull injuries (like skull fractures or brain injury after trauma)
• Nerve-related conditions (like microvascular decompression)
• Seizure disorders and epilepsy
• Swelling or pressure in your brain

What are the types of craniotomies?

There are several types. The name usually describes where your surgeon makes an opening in your skull to reach your brain. The locations include:

• Frontal: The front part of your head, near your forehead and hairline
• Temporal: The side of your head, near your eye and just in front of your ear
• Parietal: The upper part of your head, toward the top and back
• Pterional (frontotemporal): The side of your head, slightly above and in front of your ear, where your forehead meets the side of your head
• Orbitozygomatic: Near your eye socket and upper cheek
• Suboccipital: The lower back part of your head, just above your neck
• Supraorbital: Right above your eyebrow
• Retrosigmoid: Right behind your ear

Craniotomy techniques

You might hear your surgeon describe the techniques they’ll use. These include:

• Awake: Your surgeon briefly wakes you up during surgery to perform simple tasks, like talking or moving, to help protect important brain functions. You’re then put back to sleep.
• Traditional: You’ll be under general anesthesia and asleep for the entire procedure.
• Endoscopic: Your surgeon uses a thin tool with a small camera on the end. They place it through a very small opening in your skull to see and do the surgery.
• Keyhole: Your surgeon intends to make only a small opening in your skull. This approach may reduce incision size and recovery time.
• Stereotactic/navigation: Your surgeon uses imaging, like an MRI or CT scan, to guide the surgery with high accuracy.

Awake craniotomy

Some types of surgery require you to be awake for part of the procedure. This happens when your surgeon needs to check how your brain functions. It’s most common when surgery involves areas that control movement, speech or vision.

Even if you’re awake, you won’t feel pain. The brain itself can’t feel pain. Your care team will give you medicine to keep you comfortable and calm.

How should I prepare for a craniotomy?

Before surgery, you’ll meet with your surgeon. They’ll plan the procedure and check your overall health. Your care team will run tests to make sure it’s safe for you. They’ll also help plan your care during and after the procedure.

Instructions your surgeon may give you to prepare include:

• Arriving on the day of surgery with an empty stomach
• Stopping certain medicines, like blood thinners, several days before surgery
• Taking prescribed medicines before surgery, like antibiotics, seizure medicine or steroids

Your surgeon will explain the procedure itself, possible side effects, healing time and what to expect afterward. Don’t hesitate to ask questions.

What happens during a craniotomy?

Every craniotomy is different. The steps can vary based on the type of surgery and the reason you need it.

You’ll start by getting anesthesia so you don’t feel pain. You’ll either be fully asleep throughout the entire surgery or be awakened for part of it.

Here’s what you might expect next:

1. Head positioning: Your surgical team carefully positions and secures your head to keep you safe and avoid pressure points.
2. Incision area prep: Your surgeon shaves a small area of hair if needed, cleans your skin and marks where the cut (incision) will go. (Your hair should grow back after surgery.)
3. Making the opening: Your surgeon makes a cut in your scalp and moves muscle aside to reach your skull.
4. Removing a piece of your skull: Your surgeon drills small holes and removes a section of bone. They set this piece aside to replace later.
5. Reaching your brain: Your surgeon opens the protective covering of your brain to reach the treatment area.
6. Treating the issue: Your surgical team does the planned procedure. This step is usually the longest part of the process. Your surgeon may use a microscope to assist with delicate steps.
7. Closing your skull: They put your skull bone back in place and secure it with small plates or screws.
8. Closing the incision: Your surgeon moves tissue back into place and closes your scalp.

How long does a craniotomy take?

Procedures can take three to five hours, but this can vary. Your provider will give you a time estimate before your surgery so you and your loved ones know what to expect.

What are the benefits of a craniotomy?

The benefits depend on why you need it. In general, the goal is to treat the problem that’s causing symptoms. This may include:

• Removing a brain tumor or blood (hemorrhage)
• Repairing damaged blood vessels, bone or brain tissue
• Treating a serious brain condition

In many cases, this procedure may prevent life-threatening outcomes. It may improve both safety and your long-term health. Your surgeon will explain the expected benefits based on your situation.

What are the risks of a craniotomy?

All surgeries have risks. This is a major procedure, and possible risks may include:

• Bleeding
• Blood clot
• Brain swelling
• Cerebrospinal fluid leak
• Headaches
• Infection
• Pain or discomfort (at the incision site)
• Seizures
• Stroke
• Coma

Your surgeon will review these risks with you and explain how your care team will work to prevent them.

What are the long-term side effects of a craniotomy?

Long-term side effects are rare. Possible long-term side effects may include:

• Behavior or personality changes
• Changes in appearance from scarring
• Difficulty walking or moving
• Problems with balance or coordination
• Trouble speaking or saying words clearly

These risks are usually specific to the location of the surgery in your brain.

Craniotomy recovery

Recovery after a craniotomy happens in stages while you’re in the hospital. You may need to stay in the ICU (intensive care unit) for a short time before moving to a regular hospital room.

Your care team will guide you through each step based on the type of surgery and how you’re healing. Here’s what you can expect:

1. Close monitoring after surgery: Your care team will check how your brain is working, your blood pressure and your breathing.
2. Pain and comfort care: You’ll receive medicine to manage pain and help you rest.
3. Preventing complications: You may get medicine to prevent seizures, blood clots or infection. Your care team will monitor your fluid and electrolyte levels.
4. Getting up and moving: When it’s safe, your care team will help you sit up, stand or walk. Early movement may reduce the risk of problems like blood clots and lung issues.
5. Eating and drinking: You’ll slowly return to drinking fluids and eating food as your body allows.
6. Follow-up imaging: Your provider may order scans to check healing and make sure surgery worked as planned.
7. Supportive therapies: You may work with physical therapy, speech therapy or rehabilitation specialists. These teams help with strength, movement, speech or daily activities.
8. Recovery at home: Before you leave the hospital, your care team will give you instructions about rest, activity, wound care and follow-up visits.

Recovery looks different for everyone. Your provider will explain what to expect and help support you through each stage of healing.

What’s the recovery time?

You may need several weeks to recover. It could take a few months, depending on the reason for surgery and your overall health. Most people stay in the hospital for several days, sometimes up to a week, after the procedure.

Your care team will tell you when it’s safe to return to daily activities, including work or school. You’ll need time to rest and heal. Don’t do heavy lifting or hard physical activity until your provider says it’s safe.

What’s the life expectancy after a craniotomy?

Your life expectancy after a craniotomy depends on the reason for the surgery, your overall health and how complex the procedure is.

Your surgeon will review the risks and expected outcomes with you. This may help you understand how surgery might affect your health so you can make informed decisions about your care.