Craniotomy is a surgical procedure to temporarily remove of a part of the bone from the skull, for better access to the intracranial area of the brain. The temporarily removed portion of the skull, called bone flap, is replaced to its original position and fastened to its place with screws and plates.
If the bone plate is not replaced, then the procedure is called Craniectomy.
Depending on which portion of the skull is removed and replaced on, the procedure is categorized into Frontal, Pterional or Junctional Crainotomy.
A craniotomy that involves the use of a camera with a lighted scope inserted through a small incision in the skull is called an endoscopic craniotomy. When imaging and computer assisted navigation system are used in a craniotomy procedure, it is called stereotactic craniotomy.
Brain disorders which cannot be treated without surgery
The doctor will instruct the following:
Stopping blood thinning medications, at least 10 days before the surgery
Fasting for 8 to 10 hours prior to the procedure
Washing hair a night prior to surgery, and ensuring dry hair so that head can be shaved properly.
MRI scan is scheduled pre-surgery for a better understanding of the approach required to be taken by the surgeon.
Craniotomy is generally performed under general anesthesia by an experienced neurosurgeon, and can take upto 4 to 6 hours.
During the procedure, the surgeon will
Shave the part of the head to be operated on and the skin will be cleansed.
Insert an IV line in the arm and a urinary catheter to drain the urine.
Depending on the type of the procedure, make an incision from behind the ear to the nape of the neck, or in another location depending on the location of the procedure. For endoscopic surgery, incisions are smaller.
Pull the scalp back and access the brain. Drill or medical saw may be used to cut the skull.
Bone flap is removed, and thick covering below the bone is separated from the bone. Fluid is allowed to flow out.
Unhealthy tissue in the brain is removed using a specialized equipment. Intracranial pressure is also measured.
Once the surgery is complete, the bone flaps are reattached. This is done with the use of medical screws and plates
Suture the incision and apply the bandage.
After the procedure is complete, the patient is generally required to stay in the hospital for 7 to 10 days.
Some swelling in the head may be observed after the surgery. During the hospital stay, there will be frequent checks to ensure the body is in coordiantion with brain. For example, pupils will be checked by flashing light on the eye, strength of arms and legs will be tested.
After discharge, the doctor will recommend
Doing deep breating exercises, allowing the lungs to expand and contract, thereby preventing pneumonia
Walking around a little to prevent clotting of blood in the legs and ensuring faster recovery
Exercising with the help of a physiotherapist
To avoid lifting heavy objects for a few weeks
Complete recovery takes 2 to 3 months after the procedure.
Risk and Complication
Craniotomy is a complicated surgery which may have the following risks and complications:
Brain hemorrhage (bleeding)
Pneumonia and infection in the lungs
Swelling of the brain
Formation of blood clots
Cerebrospinal fluid leakage
In rare cases, paralysis or memory problems
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