Craniotomy

What is a craniotomy? 

A craniotomy is a major brain surgery that involves the temporary removal of the bone flap that covers the skull.

The procedure allows the surgeon to access the brain and fix the diagnosed problem. It could be a traumatic brain injury or a brain tumor.

Once the condition has been treated, the surgeon replaces your skull bone with screws and metal plates holding it in place.

Craniotomies differ in size and location, based on the working space your surgeon needs to conduct a successful and safe procedure.

Some craniotomies rely on advanced technologies such as computed tomography (CT) and magnetic resonance imaging (MRI) to guide them.      

Who needs a craniotomy? 

A craniotomy can help to treat the following conditions: 

• Blood clots

• Epilepsy

• A tumor

• Pressure or swelling in your brain

• Arteriovenous malformation causes tangled blood vessels

• Vascular malformations (blood vessels collecting abnormally)

• Aneurysm (enlarged artery)

• A fractured skull

• Abscesses

• Bleeding in the skull

• Brain cancer

Types of craniotomies 

Craniotomy procedures are of various kinds. These are categorized based on the following: 

Size 

Your surgeon may refer to a craniotomy based on its size. For instance, a keyhole craniotomy refers to a minimally invasive procedure in which your surgeon makes a small opening in which an endoscope fits. 

A supra-orbital craniotomy is ideal for a tumor that is too near vital arteries or the optic nerves. It is also recommended for a very large tumor.

Since “eyebrow” craniotomy is a minimally invasive procedure, it is less painful compared to open craniotomy. 

There is minimal scarring plus recovery is quicker. 

“Keyhole” craniotomy is a minimally invasive procedure in which the neurosurgeon makes a small incision behind your ear. This is to permit the removal of skull base tumors.

“Keyhole” craniotomy is recommended for metastatic brain tumors, meningiomas, and skull base tumors. 

A burr hole craniotomy is the smallest kind of craniotomy.  

Location 

A craniotomy is also named depending on the type of bone that your surgeon needs to cut through to gain access to your skull. 

A temporal craniotomy is situated on the front side of your ear adjacent to the eyes.

Frontal craniotomy is located on the front of your skull adjacent to the hairline.

Parietal is situated in the upper and top-middle section of the skull.   

Surgical technique 

Craniotomies can also be identified based on the surgical technique, or technology adopted by your neurosurgeon.

Stereotactic craniotomy is based on three-dimensional imaging technique such as CT or MRI that allows your surgeon to identify the treatment area with high precision.

The neurosurgeon relies on computer software to establish where incisions are to be made. 

Preparing for a craniotomy 

Before a craniotomy, your primary care provider will arrange preoperative appointments with our surgeon so that together you can plan the surgery accordingly.

Your surgeon will want to assess your overall health including the reasons for a craniotomy. He or she will order several tests that include:

• Blood work

• Physical examination

• Imaging tests – These include PET scan, MRI, angiography, and CT scan

The above tests are also important as they help your anesthetist to help him/her establish the dosage of anesthetic you will receive.

The result of such tests helps your surgeon establish the surgical site depending on the craniotomy and medical condition.

Your surgeon will also assist you in getting ready for craniotomy by doing the following:

• You will be asked to fast on the night before surgery. That way, you will go for surgery on an empty stomach

• If you are on blood thinning medication, your surgeon will ask you to stop taking them for a few days before the procedure

• You will also be asked to avoid taking corticosteroids or antibiotics before a craniotomy

• The surgeon will also go through the results of the tests ordered. He or she will explain what the surgery entails

• You will be fully informed of the benefits of a craniotomy and the side effects that may accompany the surgery

• Your surgeon will also discuss the success rate of a craniotomy with you and the healing time

• You will also be requested to sign a consent form allowing the surgeon to go ahead with the procedure

• Make sure you have fully understood what the consent form entails

• In case of any queries, be sure to run them through your surgeon so that you can get satisfactory answers before the procedure

During a craniotomy 

On the day of a craniotomy, you will be required to remove any jewelry and clothing on you.

The surgical nurse will assist you with a hospital gown. 

You will be instructed to lie down or sit on the operating table. 

Your head is positioned in place by a head device and the position of your body and head is adjusted accordingly. This minimizes the buildup of pressure at any point. 

The anesthetist will insert an intravenous tube through your hand or arm.

A urinary catheter is inserted in your bladder.

You will receive general anesthesia through the intravenous line. His will make you fall asleep. 

Some craniotomies require that you remain awake over the duration of the procedure. This is important in helping your surgeon assess whether certain brain functions such as speech, vision, and movement are functioning properly.

For an “awake” craniotomy, you will need a localized anesthetic. 

The hair around the surgical site is shaven clean and cleaned through using antiseptic soap. This will help to minimize infections.

The location of the opening differs based on the type of craniotomy you are undergoing.

The neurosurgeon may decide to move or adjust muscles around the skull.

The neurosurgeon drills holes in the skull and uses a surgical drill to remove part of the skull.

The piece of skull removed is placed on a surgical instrument table.

The surgical team will need to sew it back in place once they have treated the condition.

The next part is to repair or remove part of the brain depending on the reasons for your craniotomy.

After the brain condition has been treated, your surgeon will stitch the part of the skull removed and close up the incision.

A craniotomy takes between three and five hours if there have been no complications. It may also last longer if your surgeon needs to do more work.

After a craniotomy  

After a craniotomy, the surgical nurse wheels you to an intensive care unit (ICU) where the healthcare team continues to monitor your vital and progress after surgery.

The healthcare team retains the breathing tube in place until the effects of the anesthetic have worn off completely.

The surgical nurse will keep your head elevated to minimize the buildup of intracranial pressure.

The medical team will cover the wound with a soft dressing.

Pain medication will be prescribed as necessary.

Your neurosurgeon will also order periodic tests to assess whether there has been any brain damage.

You may have to take certain medications based on the craniotomy you have had.

Anticonvulsant medication helps to avoid seizures while steroids are important for controlling swelling.  

The surgical team will teach you deep breathing exercises to reduce the risks of pneumonia.

Your healthcare provider will keep the urinary catheter in place for a few days. 

Since your movement is limited, it may be necessary to have compression devices. These are necessary for avoiding blood clots. 

Before you go home, your doctor will give you instructions on how to take care of yourself at home as you recover. This includes instructions on taking care of the incision and bathing.

You will require sufficient rest to recover quickly.

Some people need occupation, speech, or physiotherapy to regain balance, strength, and talking functions. 

Your surgeon will organize post-surgery appointments to determine how your healing is progressing. You will be advised on when to resume certain activities.

Benefits of a craniotomy 

The benefits of a craniotomy differ depending on the reason for the procedure.

Craniotomy helps with the following: 

• It treats an underlying brain condition such as a seizure

• It assists with the removal of a tumor

• It improves your life expectancy by treating life-threatening complications

Risks 

A craniotomy may be accompanied by certain risks and complications. These include:

• Seizures
• Infection
• Bleeding
• Coma
• Headache
• Stroke pain
• Blood clots
• Brain swelling
• Weak muscles
• Pneumonia
• Bleeding
• Uncontrollable blood pressure

Recovery after a craniotomy 

You will take several weeks to recover from a craniotomy. 

• Your incisions will be sore after the procedure
• You will also feel pain or numbness around the site of the incision
•  Sometimes, a craniotomy causes bruising and swelling around your eyes.
• The incision site may feel itchy as it heals
•  Ice packs and medication will help to ease such swelling, pain, and itching
•  Your incisions are held in place by staples or stitches.
• You will need to have an appointment to have the staples or stitches removed after a week following surgery
•  Other staples or stitches will go away on their own
•  In case your head was shaved before craniotomy, you can opt to wear a scarf or hat as you wait for your hair to grow
• The surgical team will advise you on what to do to care for yourself while at home
• You will be advised to get enough sleep and rest
•  Walking is also recommended because it reduces constipation while also promoting blood flow
•  Do not lift heavy objects
•  Your doctor will advise you on when it is okay to drive
• You will be advised on the amount of fluid to take after craniotomy
• A normal balanced diet will also promote faster recovery
• If you were on any prescribed medication before the surgery, your doctor will advise you on when to resume taking it
• Keep the incision site dry and clean

Cost of a craniotomy in India

The cost of a craniotomy in India ranges from Rs. 2,93,040 to Rs. 3,90,720.

If you were to undergo the same procedure in the UK or the United States, you would this would set you back $6000.

Having a craniotomy in India is highly affordable. It is just 20% of what you would pay in the UK or the United States.

The cost of craniotomy in India is determined by the following factors:

• The type and the stage of cancer

• Length of stay in hospital

• Type of hospital where the craniotomy is done. For a private clinic, you will pay more for the same procedure in a public healthcare facility

• The type of room admitted: single deluxe rooms are more expensive than general or twin-sharing rooms

• Cost of diagnostic tests: In case your healthcare provider has ordered blood tests or ECG, you may end up paying more for a craniotomy

• Cost of accommodation: International patients who get accommodation arranged by a healthcare provider end up paying more for a craniotomy in India than local residents

References

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