Surgical Procedures: Craniotomy

What is a craniotomy and how is it done?

The skull is made up of 22 bones. The skull protects the brain and supports cranial soft tissue. Another word for skull is “cranium.” A craniotomy is a procedure that is done to open part of the skull to access the brain.

A craniotomy may be done in some cases of:

• Brain tumors and/or the need for a brain biopsy.
• Head trauma.
• Aneurysm repair.
• Blood clots.
• Problems in blood vessels.
• Nerve problems.
• Brain swelling.
• Infection.
• Repair of a torn dura mater (brain lining).
• Hydrocephalus.
• Epilepsy.
• Arteriovenous malformation (AVM).
• Parkinson’s disease or dystonia with an internal stimulator device.

There are many types of craniotomy:

• Endoscopic Craniotomy: A surgical tool with a lighted scope and camera at the end of it is used. It is put into the skull through a small incision (cut).
• Stereotactic Craniotomy: A CT scan or MRI is used to find the area of the brain needing treatment.
• Extended Bifrontal Craniotomy: An incision is made behind the hairline. The bone that forms the orbital (eye socket) and forehead shape is removed.
• Minimally Invasive Supra-Orbital “Eyebrow” Craniotomy: A small incision is made within the eyebrow. The benefits include less pain, faster recovery, and less scarring.
• Retro-Sigmoid “Keyhole” Craniotomy: A small incision is made behind the ear. The benefits include less pain, faster recovery, and less scarring.
• Orbitozygomatic Craniotomy: The bone that makes the cheek and the orbit (eye socket) is removed for a period of time. This is done to lessen brain damage and allow for better access to the brain.
• Translabyrinthine Craniotomy: An incision is made behind the ear. The mastoid bone and inner ear bones are removed. This often causes hearing loss that doesn't get better.
• Craniectomy: Part of the skull is permanently removed.

What are the risks of a craniotomy?

There are risks and side effects related to having a craniotomy. Risks and side effects may be:

• Reaction to anesthesia (the medication you are given to help you sleep through the surgery, not remember it, and to manage pain). Reactions can be wheezing, rash, swelling, and low blood pressure.
• Infection.
• Bleeding.
• Blood clots.
• Pneumonia.
• Unstable blood pressure.
• Swelling of the brain.
• Seizures.
• Heart attack.
• Muscle weakness and/or paralysis (loss of the ability to move and sometimes feel).
• Leaking of cerebrospinal fluid (fluid that surrounds your brain and spinal cord).
• Memory, balance, vision, hearing, bowel and bladder, or speech problems.
• Coma.

Your surgeon and healthcare team will talk with you about the risks of your procedure.

What is recovery like?

Recovery from a craniotomy will depend on the type of procedure you had. Often, a 3-7 day hospital stay is needed. A temporary urinary catheter may be placed to drain your urine after surgery.

You will be told how to care for your surgical incisions and will be given any other instructions related to your recovery before leaving the hospital.

Your healthcare team will teach you about the medications you will be taking, such as those for pain, blood clot, infection, constipation, and seizure prevention and/or other conditions.

Your healthcare team will talk to you about any activities you should avoid. In general:

• Follow the instructions you have been given on how to care for your incision. Be sure to keep the surgical incision clean and dry.
• Bathe as directed by your healthcare team. You may be asked to wash your hair daily.
• Avoid dying your hair or getting a perm for 4 weeks after surgery.
• Don't wear a wig until about 3 to 4 weeks after surgery. It will take time for your surgical incision to fully heal. Ask your provider if a loose turban or hat is okay to wear.
• Take pain medications as prescribed. Speak with your healthcare team before taking aspirin, ibuprofen, or other blood thinning medications.
• Do not put topical (applied to the surface of the skin) medications/skin products on the surgical incision unless your team tells you to do so.
• Avoid being around people who have a cold, the flu, or other respiratory infections.
• Do not lift, push, or pull anything heavy.
• Do not exercise until your team tells you that you can.
• You may be able to return to work within 4-6 weeks depending on your job and your recovery. Talk with your healthcare team before returning to work.
• Ask your provider when you can drive.

What will I need at home?

• Thermometer to check for fever, which can be a sign of infection.
• Wound/Incision care supplies.

When to call your provider

Contact your healthcare team with any of the following symptoms:

• Fever. Your team will tell you at what temperature they should be notified.
• Any new or worsening pain.
• Redness, swelling, drainage, or bleeding at the incision.
• Chills/shivering.
• Phlegm or mucous that is green, yellow, or blood-tinged.
• Headache that won’t go away.
• Stiff neck.
• Behavioral changes and/or mental status changes, confusion, and/or depression.
• Drowsiness, fainting, and/or seizures.
• Vision changes.
• Balance, strength, or movement changes.
• Facial, arm, or leg numbness, tingling, and/or weakness.
• Nausea/vomiting that doesn’t go away and/or not being able to keep down food or drink.
• Bowel and/or bladder changes like having a hard time urinating or having a bowel movement, and/or having a hard time controlling your bowel and/or bladder.
• Coughing, shortness of breath, problems breathing, and/or chest pain.
• Leg swelling, tenderness, redness, or warmth.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection, and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.