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Craniotomy is a procedure that involves the removal of a fragment of the skull bone. A craniotomy is performed so that the neurosurgeon can access the brain. A variant of craniotomy is craniectomy, however, it is distinguished by the fact that during craniotomy, the removed fragment of the skull bone is placed back in the same place after the procedure. Access to the brain enables the treatment of pathological changes within it. What are the indications for a craniotomy? What are the possible complications of craniotomy?
Craniotomy – what is it?
The craniotomy procedure is performed by a surgeon or neurosurgeon using general anesthesia, but sometimes it is necessary to awaken the patient. The most common type of craniotomy that is performed is the frontotemporal craniotomy. However, other bones, such as parietal, frontal or temporal, are also removed during craniotomy. During the procedure, a given bone fragment is cut and removed. This, in turn, allows access to the brain and necessary procedures within it. However, before the skull bone fragment is removed, the patient must be properly prepared. It involves shaving off the hair at the site where the craniotomy will be performed.
The patient is then given an agent that induces general anesthesia. Subsequently, the craniotomy involves the need to separate the scalp flap (skin on the head) from the skull bone, which will be removed. The next step the surgeon performs is making a few small diameter holes in the bone. Between these holes, a specialist saws the bone using a suitable tool. The cut bone fragment is removed and set aside to protect it. However, for the surgeon to get to the brain, it is not enough just to remove a bone fragment. There must also be a separation of the dura mater from the brain. Only then can the appropriate therapeutic measures be performed, depending on the cause of the craniotomy. After performing these steps, the surgeon attaches the cut bone back to the brain. The connection between the cut bone and the rest of the skull bone is secured by the use of specialized sutures or plates. The procedure also includes sewing on a flap of skin that has been previously excised for the purposes of the procedure.
Craniotomy – indications
Typical indications for craniotomy are: malformations (hemangiomas) of the brain vessels, intracranial hematomas resulting from trauma, tumors in the brain (central nervous system), cerebral vascular aneurysms, brain abscesses, brain tumors, increased intracranial pressure and seizures. In the case of epileptic seizures, craniotomy is necessary so that the surgeon can reach the brain where the epilepsy lesions are located. Then, it is possible to implant a device that stimulates the bioelectric activity of the brain.
Craniotomy with recovery
As mentioned, craniotomy sometimes requires awakening the patient during its duration. It is dictated by the necessity to check the patient’s condition during the procedure. This, in turn, results from the frequent need for the surgeon to perform operations within important brain centers, e.g. the speech motor center or the sensory speech center. Intraoperative awakening of the operated person makes it possible to assess whether the operation is performed correctly and, if necessary, to modify the action plan. A patient who undergoes an awake craniotomy must not suffer from any mental disorders, as well as impaired functions of the upper respiratory tract, as this hinders cooperation between the patient and the surgeon. For many reasons, awakening craniotomy is performed only in people who suffer from specific ailments, e.g. mycotic aneurysms, tumors or arteriovenous malformations (angiomas). During the recovery craniotomy, the patient is treated with sedatives and opioid analgesics. This combination makes it possible to regulate the patient’s state of consciousness at different stages of the craniotomy.
Craniotomy – rehabilitation
Rehabilitation after a craniotomy takes from a few to several days. It depends on the reason for the procedure. Immediately after the operation, the patient undergoes intensive care and close observation, during which his vital functions and general condition are monitored. After discharge from hospital, your doctor generally recommends painkillers and anti-seizure medications that may persist for some time after surgery. After the craniotomy, it is necessary to rest for a long time and avoid excessive physical exertion, it is strictly forbidden to drink alcohol, smoke or drive a car – follow the doctor’s instructions. Also, the operated area should not be washed for several days.
Craniotomy – complications
After craniotomy, the following may occur: headache and dizziness, nausea, vomiting, fever, wound suppuration, convulsions or muscle weakness. In such cases, see a doctor.