Craniotomy

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What is a Craniotomy?

A Craniotomy is a surgical procedure in which a bone flap (section of the skull) is temporarily removed to access the brain underneath. This allows the neurosurgeon to perform operations on the brain – such as removing a tumor (as described above), clipping an aneurysm, evacuating a blood clot (hematoma), or treating other brain conditions. After the work is done, the bone flap is secured back in place. Essentially, craniotomy is the step of opening the skull; it’s part of many brain surgeries. The term can also refer broadly to the whole brain operation. If the bone is not put back (due to swelling, etc.), that’s called a craniectomy. But normally, in a craniotomy, you get your bone back on.

Craniotomies vary in size and location depending on what part of the brain needs to be addressed. For example, a frontal craniotomy for an aneurysm, a pterional craniotomy (side of head) for certain tumors or aneurysms, or a suboccipital craniotomy near the back of head for cerebellar issues. There’s also “keyhole” craniotomies – very small openings for certain minimally invasive approaches.

Who is it for?

Anyone who needs brain surgery for:

Tumors (benign or malignant) – as covered.

Vascular issues: aneurysms, arteriovenous malformations (AVMs), etc. Aneurysm clipping specifically requires a craniotomy to reach the blood vessel and place a clip on the aneurysm neck to prevent bleeding.

Hematomas/bleeds: such as a subdural hematoma or intracerebral hemorrhage that is life-threatening or causing big pressure – surgeons perform a craniotomy to open skull and remove the blood.

Trauma: depressed skull fractures or contusions may need craniotomy to elevate bone and relieve pressure.

Epilepsy surgery: sometimes a small craniotomy is done to remove a seizure focus in the brain.

Brain abscess or infections – to drain an abscess, a craniotomy might be done.

Essentially, if something inside the skull requires direct intervention and cannot be done less invasively (like through a catheter or radiation), a craniotomy is indicated.

The patient has to be fit for surgery (i.e., can tolerate general anesthesia, etc.). In emergencies like hemorrhage, a craniotomy might be life-saving so it’s done even in high risk situations if needed.

What to Expect – Before, During, After

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Specific prep depends on indication.

For aneurysm, you might have had an angiogram; surgeon will decide clipping (open surgery) vs endovascular (coiling). If clipping, similar pre-op: perhaps start on antiseizure med (some do prophylactically), ensure good blood pressure control.

For elective, you may get labs, possibly imaging like CT angiography or functional MRI depending. Shave usually just the patch of hair where incision will be, or sometimes a larger area. If emergent (e.g., bleed) – things go fast, minimal prep aside from imaging to locate problem and then straight to OR.

The surgical team explains risk/benefit unless emergency and patient can’t consent (then proceed as life-saving measure).

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Under general anesthesia (except rare cases of awake craniotomy for certain tumor or epilepsy – but that’s still anesthetized partially). They position your head in a clamp for stability. They map out incision on scalp. They inject local anesthetic in scalp to reduce bleeding and post pain. Make the incision, cut through skin and peel back a skin+muscle flap (scalp is very vascular, they cauterize to control bleeding).

Drill burr holes in skull, then use a craniotomy saw to cut an outline and remove the bone flap. They secure the bone aside (sometimes in sterile solution or just on table). Open dura to reveal brain. Now the specific procedure: e.g., find aneurysm at base of brain by gently retracting brain, dissecting through membranes, then place a titanium clip on aneurysm neck to exclude it from circulation. Or evacuate clot by suctioning blood. Or remove a lesion. They might use microscope for delicate stuff, especially aneurysms or AVM.

Once done, they ensure bleeding is controlled. Dura is closed (sometimes with a patch if shrunk). Bone flap is put back – usually tiny plates and screws are used to hold it (they remain permanently). Scalp is sutured or stapled closed. They often leave a drain under the scalp to catch fluid/blood for a day or two.

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Frequent neuro checks. Manage pain (head pain, neck stiffness maybe if SAH). For aneurysm, they also give fluids and maybe a calcium channel blocker (nimodipine) to prevent vessel spasm. If it was trauma or bleed, they monitor brain pressure signs. Steroids possibly given if a lot of swelling.

Most patients after an elective craniotomy (like for benign tumor or aneurysm) spend 3-7 days in hospital. They may have some confusion or neurological deficits initially which often improve. Again, avoid heavy lifting, don’t strain.

Incision care – often staples out at 10-14 days.

Many patients are up and around (with caution) within days – it depends on how their brain is doing.

For aneurysm, no heavy exertion for a while (to keep BP stable.

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People generally return to normal life after recovering from craniotomy once brain is healed from whatever was done. If an aneurysm was clipped, that aneurysm is gone for good (cured usually), they just have to manage risk factors to avoid others (control BP, quit smoking). If it was a bleed from hypertension, manage BP etc. They might be advised against heavy contact sports (because head had surgery, though once healed bone is quite strong – but plates could break if extreme trauma).

Benefits

Benefits include:

Treating the Underlying Problem: Craniotomy itself is a means to an end – whether it’s removing a tumor, clipping an aneurysm (preventing deadly hemorrhage), or evacuating a life-threatening bleed. The benefit is directly addressing a serious condition that could worsen or be fatal without intervention.

Symptom Relief and Prevention: If you had neuro deficits or headaches from tumor or pressure, removal via craniotomy can relieve those. If aneurysm not yet ruptured, clipping prevents a subarachnoid hemorrhage which is often catastrophic. If it already ruptured, clipping secures it to prevent rebleed and improve survival.

High Success Rates in Experienced Hands: Many brain surgeries, while complex, have high rates of achieving their goal (e.g., aneurysm clipping success in isolating aneurysm, meningioma complete resection often possible).

Technological Advancements: Modern craniotomies use neuronavigation, intraoperative imaging, and monitoring to maximize safety and efficacy. So outcomes today are better than decades ago. Minimally invasive variations (like keyhole approaches or endoscopic assistance) can reduce collateral damage.

Life Saving: In trauma or large strokes, a decompressive craniotomy (taking off bone to allow swelling) can be life saving and prevent severe brain damage. Even though that’s not exactly removing a lesion (it’s temporarily removing skull to allow swelling then replacing later), it’s still a craniotomy procedure with major benefit of saving life and reducing disability.

Access for Biopsy/Diagnosis: Sometimes a craniotomy is done to biopsy a lesion and that’s critical to know what we’re dealing with for further treatment.

Risks

General Brain Surgery Risks: bleeding, infection, stroke, seizures, swelling, CSF leak, need for transfusions, and in rare instances coma or death depending on condition severity (e.g., emergent bleeds have high baseline risk).

Specific Functional Loss: If operating near specific brain regions, could result in specific deficits (speech, movement, vision, memory, etc). We use mapping to avoid, but risk is not zero. E.g., risk of weakness or speech issues if tumor near those areas, or visual field cut if near optic pathways (like some aneurysm clippings risk vision changes).

Anosmia: A trivial but sometimes present risk if frontal lobe area is approached – you can lose sense of smell on one or both sides because olfactory nerves might be sacrificed in certain exposures.

Bone Flap Issues: Rarely, bone flap can get infected or resorbed (especially in kids or with radiation, bone can thin out). If infected, might need removal and later cranioplasty. If resorbed (dissolves away), might need replacement. If a craniectomy was done (no bone put back immediately), patient is without bone covering brain until a later surgery (must wear a helmet, etc., but that’s planned).

Scarring and Cosmesis: There will be a scar on scalp. Hair often grows back around it so not very visible, but if a large portion shaved, hair takes time to regrow. Minor risk of scalp numbness around the incision because some superficial nerves are cut (often people have a patch of numb scalp that can shrink over time).

Brain herniation or edema: If lots of swelling post-op, can cause pressure problems requiring interventions (medical or surgical).

Longer Hospital Stay/Recovery: It's not a quick in-and-out surgery; risks of hospital stays (like blood clots in legs, pneumonia if not mobilizing quickly, etc) exist, but we mitigate by early mobilization and prophylaxis.

For aneurysm specifically: risk of vessel spasm after bleed (can cause stroke, but ICU care aims to prevent/treat this), risk that aneurysm might bleed during surgery (surgeon prepared to control that).

Psychological effects: Some patients experience depression or anxiety post brain surgery (maybe due to the trauma or steroid effects), which is usually manageable and transient.

Frequently Asked Questions:

Is a craniotomy very dangerous?

It sounds scary, but for many planned surgeries in otherwise stable patients (like for a meningioma or aneurysm), the risk of serious complications (like major stroke or death) is relatively low – often just a few percent or less in experienced hands for those specific cases.

Of course, it depends on what we’re doing: an emergency craniotomy for a massive stroke in an older patient carries more risk because the situation itself is dangerous. But surgeons do a lot to minimize risks: careful planning, modern monitoring, etc.

If we recommend a craniotomy, it’s usually because the risk of not doing anything (or the condition itself) is higher than the risk of surgery. Most patients do very well, especially for benign conditions. That said, any brain surgery is not trivial, and we are meticulous to avoid complications.

We will discuss your individual risk profile (e.g., tumor near motor area might carry risk of weakness, etc., so maybe a 5% chance of some weakness, etc.). But overall, craniotomies for accessible, well-defined issues have a high success and acceptable risk which is why they’re done.

If risk was extremely high and benefit uncertain, we’d consider alternative treatments. So while no brain surgery is “routine,” many are safely performed every day with good outcomes.

Will I be awake during brain surgery?

In most cases, you’ll be fully asleep (general anesthesia) and you won’t feel or remember anything from the surgery itself. Your head does get fixed in a clamp but you’re anesthetized before that’s applied.

There is a special scenario called an “awake craniotomy” often used for tumors or epileptic foci near critical brain areas (like speech). In that case, you are awakened during part of the surgery so that we can map functions – you’d be asked to talk or move a limb while we gently stimulate brain areas to identify what’s safe to remove. But you are given sedation and numbing such that you don’t feel pain even when awake.

It’s a weird experience but patients generally handle it well and the team guides you. If we need to do that, we’ll prepare you extensively so you know what to expect. If not needed, you stay asleep the whole time.

For aneurysm clippings, you are typically fully asleep; for tumor in silent area, fully asleep. So being awake is the exception, not the norm, but it’s used when it can improve safety of removing something near vital brain functions.

How big will the scar be and will I have to shave my head?

Surgeons try to minimize incision length while still doing the job. Typical incisions might be a few inches long. For example, a temporal craniotomy might have a question-mark shaped incision behind the hairline. A frontal might be along the hairline or a bit on forehead (which can be hidden by hair if possible). For posterior, often along midline if going for cerebellar area.

We don’t usually do the old style of shaving the whole head. Usually just the incision area plus a small margin. If your hair is long enough, sometimes they even part the hair and just shave a strip along the incision line – so you can comb hair over shaved area later. It depends on surgeon preference and required sterility.

After surgery, hair will grow back over a few months. The scar typically heals to a thin line. Many are placed in hair-bearing scalp so they are not visible once hair grows. If some scar is on forehead or behind ear, it’s often not too noticeable after healing (initially red, but fades).

We’ll give you scar care instructions (keeping out of sun, possibly scar gels) to optimize cosmetic outcome. People who want can cover scar with hairstyle or makeup if needed. But generally, most patients look quite normal after a full recovery; casual observers may not even know they had brain surgery.

Will I lose any hair permanently?

The shaving itself is temporary – hair will regrow from that unless the hair follicles are damaged by the incision scar itself. So, along the line of the incision, there may be a very thin area where hair won’t grow (scar tissue doesn’t have follicles). But usually that line is thin and if covered by surrounding hair, you won’t notice a little stripe of no hair.

If an incision goes across hairline, there could be a slight unevenness – again, usually not a big cosmetic issue. So aside from the scar line, the rest of shaved hair grows back just fine.

On rare occasions, radiation therapy (if needed afterwards) could cause hair loss in the radiation field, sometimes permanently in patches. But surgery itself only directly affects hair at the incision. We also handle the scalp gently to ensure good blood supply so hair grows back normally.

What precautions do I need to take after I go home?

We’ll provide a detailed list. Key points:

Keep your incision dry and clean. Usually you can shower after a few days (if we say okay) but no soaking head underwater (no baths or swimming) until fully healed.
Watch for signs of infection: increased redness, swelling, drainage of pus, fever – report if seen.
No heavy lifting (>5–10 lbs) or strenuous exercise for at least a few weeks (the brain and bone need to heal, and strain can raise intracranial pressure or disrupt repair).
Don’t drive until cleared – often 2–6 weeks depending on reason and your status (if had seizures, follow seizure-free period law).
Avoid alcohol initially as it can increase swelling or seizure risk, and interact with meds.
Take medications as prescribed (e.g., complete steroid taper if given, anti-seizure meds if prescribed).
Try not to blow your nose too hard if you had skull base work (to avoid CSF leak).
Diet generally normal unless told otherwise – some patients on steroids might need a low-salt diet.
You can do light activities: walking, gentle household tasks as tolerated, just listen to your body – rest when fatigued.
Protect your head from injury – wear a helmet if biking, avoid risky activities until surgeon says bone is solid.
If any new neurological symptoms appear (worsening headache not relieved by meds, increasing drowsiness, weakness, confusion, seizures, vision changes, etc.), contact us or ER immediately.
We’ll schedule follow-ups: one sooner for wound check, another later for progress and any necessary further treatment coordination.

Emotional support is also important – some people have mood swings post-craniotomy due to the stress and steroid medications. Let family know to be patient and help you, and let us know if you feel very down or anxious – we can provide resources or temporary medications to help through recovery if needed.

Contact Us Today!

When it comes to conditions of the brain that require surgery, you want to know you’re in the most capable and caring hands.

At One Tree Health, our neurosurgeons have the expertise and technology to perform critical craniotomy procedures with precision and compassion. We take on the serious responsibility of opening the skull to heal what lies beneath, always with your safety and best outcome as our top priority.

From removing life-threatening tumors and clipping aneurysms, to evacuating dangerous brain bleeds – we stand ready 24/7 to deliver advanced neurosurgical care. We’ll guide you and your family through the process, ensuring you understand each step and feel supported the entire way.

After surgery, our team works diligently on your recovery, maximizing your neurologic function and comfort.

If you or a loved one are facing a brain condition that may require surgery, don’t hesitate – reach out to One Tree Health’s Neurosurgery team now. We will provide a prompt evaluation, discuss all your options (including non-surgical ones if appropriate), and if a craniotomy is needed, you can trust our skilled surgeons to handle your brain with the utmost care and skill.

Your brain is you – and we’re dedicated to protecting it. Call us today for an appointment or second opinion. Let us put our experience to work for your healing, so you can focus on living your life to the fullest again.

Your health is our mission – and we’re here for you every step of the way, from diagnosis to recovery. Contact One Tree Health Neurosurgery to take the next step toward a solution and peace of mind.

OneTreeHealth provides coordinated, compassionate care for patients recovering from injury specializing in orthopaedics, neurology, surgery, interventional pain management, and more. We simplify the recovery journey by managing care under one roof, so patients can focus on healing.

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