What is a craniotomy?
A craniotomy is the surgical removal of part of the bone from the skull to expose the brain for surgery. The surgeon uses special tools to remove the section of bone (the bone flap). After the brain surgery, the surgeon replaces the bone flap and attaches it to the surrounding bone with small titanium plates and screws. If part of the skull bone is removed and not replaced right away, it is called craniectomy. This is done if swelling is likely after brain surgery or if the skull bone flap can't be replaced for other reasons. After a few weeks to months, you may have a follow-up surgery called a cranioplasty. During a cranioplasty, the missing piece of skull will be replaced with your original bone, a metal plate, or a synthetic material.
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For some craniotomy procedures, doctors use MRI or CT scans. Imaging helps guide the doctor to the exact place in the brain that is to be treated. When computers and imaging are combined to make 3-D pictures, it called image-guided craniotomy or stereotactic craniotomy.
A craniotomy can be done with various tools that help the surgeon see the area of the brain. These include loupes, a microscope, high-definition cameras, or an endoscope. A craniotomy with an endoscope involves putting a lighted scope with a camera into the brain through a small hole in the skull.
What happens after a craniotomy?
In the hospital
Right after the procedure, you will be taken to a recovery room to be closely watched before being taken to the intensive care unit (ICU). In some cases, you may be taken directly to the ICU from the operating room.
In the ICU, you may be given medicine to decrease the brain swelling.
You may have in place a brain intracranial pressure (ICP) device to monitor the pressure in your brain. Or you may have an external ventricular drain (EVD) to remove extra cerebrospinal fluid (CSF). These devices are usually removed after a few days.
You may have various catheters to get or drain fluid, or to monitor your blood pressure.
Your recovery will vary depending on the type of procedure done and the type of anesthesia you had. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the ICU or your hospital room.
After staying in the ICU and your condition is stable, you will move to a room in the hospital. You will stay in the hospital for several more days.
You may need oxygen for a while after surgery. Generally, the oxygen will be stopped before you go home.
You will be taught deep-breathing exercises to help re-expand the lungs and prevent pneumonia.
Medical staff will check your brain function often and make sure your body systems are working properly after surgery. To check your brain function, you will be asked to follow a variety of basic commands, such as moving your arms and legs. Your pupils will be checked with a flashlight, and you will be asked questions to assess your awareness. These might include your name, the date, and where you are. The staff will test the strength of your arms and legs.
The head of your bed may be raised to prevent swelling of your face and head. Some swelling is normal.
You will be encouraged to move around as you are able while in bed. As your strength improves, you will have help to get out of bed and walk around. A physical therapist (PT) may evaluate your strength, balance, and mobility, and give you suggestions for exercises to do both in the hospital and at home.
You will likely have sequential compression devices (SCDs) placed on your legs while you are in bed to prevent blood clots. SCDs have an air compressor that slowly pumps air into and out of fitted sleeves that are placed on the legs. They help prevent blood clots by passively compressing the leg veins to keep blood moving.
Depending on your case, you may be given liquids to drink a few hours after surgery. Your diet may be gradually changed to include more solid foods, as you can tolerate them.
You may have a catheter in your bladder to drain your urine for a day or so, or until you are able to get out of bed and move around. Be sure to report any painful urination or other urinary symptoms that occur after the catheter is removed, as these may be signs of an infection that can be treated.
Depending on your status, you may be moved to a rehabilitation facility for a period to regain your strength.
Before you are discharged from the hospital, arrangements will be made for a follow-up visit with your doctor. Your healthcare provider will also give you instructions for home care.
At home
Once you are home, it is important to keep the incision clean and dry. Your doctor will give you specific bathing instructions.
You may choose to wear a loose turban or hat over the incision. Do not wear a wig until the incision is completely healed (about 3 to 4 weeks after surgery).
The incision and head may ache, especially with deep breathing, coughing, and exertion. Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or other blood thinning medicines may increase the chance of bleeding. Be sure to take only recommended medicines and ask if you are unsure.
Continue the breathing exercises used in the hospital to prevent lung infection. You will be advised to avoid exposure to upper respiratory infections (colds and flu) and irritants, such as tobacco smoke, fumes, and environmental pollution.
Gradually increase your physical activity as tolerated. It may take several weeks to return to your previous level of energy and strength.
You may be instructed to not lift heavy items for several weeks to prevent strain on your surgical incision.
Don't drive until your doctor gives you permission.
Seek medical care right away if you have any of these symptoms:
- Fever or chills
- Redness, swelling, bleeding, or drainage from the incision site or face
- Increased pain around the incision site
- Vision changes
- Confusion or excessive sleepiness
- Weakness of your arms or legs
- Speech difficulty
- Difficulty breathing, chest pain, anxiety, or change in mental status
- Green, yellow, or blood-tinged sputum (phlegm)
- Seizure activity
Following a craniotomy, your healthcare provider may give you other instructions about what to do after a craniotomy.