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Craniotomy: Procedure, Uses & Risks

A craniotomy is a neurosurgical procedure in which part of the skull is temporarily removed to allow access to the brain for treatment.

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Things worth knowing about "Craniotomy"

A craniotomy is a neurosurgical procedure in which part of the skull is temporarily removed to allow access to the brain for treatment.

What is a Craniotomy?

A craniotomy is a surgical procedure performed by neurosurgeons in which a section of the skull (calvaria) is temporarily removed to gain access to the brain, its surrounding structures, or blood vessels. Unlike a craniectomy -- where the bone flap is permanently removed -- in a craniotomy the bone is replaced and secured after the procedure is completed. The term derives from the Greek words “kranion” (skull) and “tome” (cut).

Indications

A craniotomy is performed when surgical access to the brain or intracranial structures is required. Common indications include:

Brain tumors: Removal or biopsy of benign or malignant tumors
Intracranial hemorrhage: Evacuation of blood clots caused by stroke or head injury
Brain aneurysms: Surgical clipping of a weakened blood vessel to prevent rupture
Epilepsy: Removal of seizure-generating brain tissue in drug-resistant epilepsy
Traumatic brain injury: Relief of pressure from swelling or bleeding
Arteriovenous malformations (AVM): Correction of abnormal blood vessel connections
Brain abscesses: Drainage of intracranial infections

Procedure

Preparation

Prior to surgery, imaging studies such as MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) are performed to precisely locate the target area. The procedure is typically performed under general anesthesia. In specific cases -- particularly when operating near areas of the brain responsible for speech or motor function -- an awake craniotomy may be performed. In this technique, the patient is kept awake during part of the operation so that brain function can be monitored in real time.

Surgical Steps

After positioning the patient, the scalp over the surgical site is shaved, disinfected, and incised. The underlying tissue layers are carefully reflected. A surgical drill is used to create small entry holes (burr holes) in the skull, and a specialized saw (craniotome) is then used to cut between these holes to free a bone flap. The bone flap is kept sterile during the procedure. Once the intracranial work is completed, the bone flap is repositioned and secured with titanium plates and screws. The scalp is then closed in layers with sutures or staples.

Awake Craniotomy

During an awake craniotomy, the patient is brought back to consciousness after the skull is opened. Because brain tissue itself has no pain receptors, this is feasible and safe. While the surgical team works on the brain, neurologists and neurophysiologists perform continuous tests -- such as asking the patient to speak, move, or identify objects -- to confirm that critical brain functions remain intact.

Risks and Possible Complications

As with any major surgical procedure, a craniotomy carries risks, which may include:

Bleeding within the brain or surgical site
Infection of the wound, bone, or meninges (meningitis)
Brain swelling (cerebral edema)
Neurological deficits such as weakness, speech problems, or visual disturbances
Seizures following surgery
Blood clots (deep vein thrombosis or pulmonary embolism)
Anesthesia-related complications

Individual risk depends on the underlying condition, the patient's age and health, and the location of the surgical site within the brain.

Recovery and Rehabilitation

After a craniotomy, patients are typically monitored in an intensive care unit (ICU) or a dedicated neurosurgical ward. Regular neurological assessments and follow-up imaging are part of standard postoperative care. Depending on the extent of the surgery and the underlying condition, neurological rehabilitation may be required to help recover lost functions or develop compensatory strategies. Recovery time varies greatly and can range from a few weeks to several months.

References

Greenberg, M.S. - Handbook of Neurosurgery, 9th edition, Thieme Medical Publishers, 2019
National Institute of Neurological Disorders and Stroke (NINDS) - Brain and Spinal Tumors: Hope Through Research, www.ninds.nih.gov
Rolston, J.D. et al. - Awake Craniotomy to Maximize Glioma Resection: Methods and Technical Nuances over a 27-Year Period. Journal of Neurosurgery, 2016, 123(2):325-339

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