A surgical procedure in which a portion of the skull is temporarily removed to access the brain — used for tumors, hemorrhages, aneurysms, abscesses, or trauma, and may be performed awake when needed.
Indication
- Brain tumors (benign or malignant, primary or metastatic)
- Intracerebral hemorrhages and subdural/epidural hematomas
- Aneurysm and arteriovenous malformation (AVM) surgery
- Brain abscesses and infection-related masses
- Traumatic skull fractures and brain injuries
- Resection of an epileptogenic focus in drug-resistant epilepsy
- Selected cases of hydrocephalus and shunt failure
Preparation
- Contrast-enhanced brain MRI and, when needed, functional MRI, DTI tractography, CT angiography
- Anesthesia consultation, blood tests, and blood reserve preparation
- Adjustment of blood thinners with physician approval
- No food or drink for 8 hours before the procedure
- Specific cleansing of the scalp at the surgical site and shaving of a small area when needed
How it's performed
- The patient is positioned appropriately and the head is fixed with a Mayfield head holder
- General anesthesia is administered; awake craniotomy may be preferred when cortical/subcortical mapping is required
- Surgical boundaries are planned with neuronavigation
- The scalp is incised, holes are drilled in the skull, and a bone flap is removed
- The dura mater is opened; microsurgery is performed using a tubular retractor or operating microscope
- At the end of the procedure, the bone flap is fixed back in place with mini plates and screws and the tissues are closed in layers
Post-procedure
- 24-48 hours of intensive-care monitoring with hourly neurologic examinations
- Early postoperative control CT or MRI
- Hospital stay averages 4-10 days, depending on the underlying condition
- An antiepileptic medication may be advised for a period to lower seizure risk
- Hair regrows within 2-3 months; the scar is largely hidden under the hair
Risks
- Neurologic deficit (temporary or permanent impairment of speech, movement, vision, or cognitive function)
- Postoperative bleeding (intracranial hematoma) and brain edema
- Infection (wound infection, meningitis, bone-flap infection)
- Cerebrospinal fluid leak and development of seizures (epilepsy)
- Anesthesia reactions, deep-vein thrombosis, and pulmonary embolism
FAQ
What is the difference between craniotomy and craniectomy?
In craniotomy, the bone flap is replaced at the end of the operation. In craniectomy (typically performed for severe brain edema), the bone is temporarily removed and stored in the body or in a laboratory and replaced after some time (cranioplasty).
Will I feel pain during awake craniotomy?
Brain tissue itself has no pain receptors. Local anesthesia is applied to the scalp and bone. The patient is awakened at certain stages so that speech, movement, or vision can be tested; pain is not felt.
What does recovery look like after surgery?
The first week requires hospital follow-up. Total recovery varies between 4-12 weeks depending on the underlying condition. Additional treatment (radiotherapy, chemotherapy, antiepileptic) may be required based on pathology or imaging results.
Can I travel by plane after a craniotomy?
Long-haul flights are generally permitted at least 4-6 weeks after surgery and with physician approval. The interval may be extended depending on wound healing and the amount of intracranial air.
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