A craniotomy is a neurosurgical procedure used to treat a variety of conditions, including brain tumors, as well as various types of blood clots and lesions that may affect the brain. When a tumor is present, the goal of a craniotomy is to relieve pressure on the brain and remove the tumor and all abnormal cells.

Baptist Health is nationally recognized for excellence in craniotomy procedures. We offer a full spectrum of neurosurgical care and the latest approaches to craniotomy surgery. Best of all, you’ll appreciate convenient appointment times, locations near you and a personalized focus to meet your needs before, during and after your procedure.

What is a Craniotomy?

A craniotomy is a neurosurgical procedure that involves temporarily removing an area of bone from the skull in order to perform surgery on the brain. There are numerous types of craniotomy that may be performed depending on the size and location of the tumor.

Extended Bifrontal Craniotomy

Used to target difficult, large tumors toward the front of the brain, this approach involves making an incision in the scalp below the hairline and removing part of the bone on the side of the forehead.

Minimally Invasive Supraorbital “Eyebrow” Craniotomy

This procedure involves a small incision on the eyebrow to reach tumors in the front of the brain.

Orbitozygomatic Craniotomy

This type of craniotomy involves removing part of the bone that forms the contour of the eye socket and cheek.

Retrosigmoid “Keyhole” Craniotomy

This minimally invasive surgical procedure allows for the removal of skull base tumors through a small incision behind the ear, providing access to the cerebellum and brainstem.

Translabyrinthine Craniotomy

When a patient’s hearing is already beyond repair or must be sacrificed due to the location of the tumor, a translabyrinthine craniotomy is used to access the brain by removing part of the skull behind the ear, including part of the inner ear bone. 

What Can Craniotomy Accomplish?

If a brain tumor is diagnosed, a craniotomy procedure can be performed to:

• Diagnose or remove a brain tumor
• Relieve pressure on brain structures to improve symptoms such as weakness, speech or memory problems

What Can I Expect During the Procedure?

Before the procedure, you will be given a neurological exam that will be used to compare with postoperative exams. You will also be asked to fast before the procedure, and may be asked to wash your hair with a special antiseptic shampoo.

At the start of the procedure, the area around the surgery site may need to be shaved. An IV line will be placed in your arm or hand, and, depending on the length of the surgery, a urinary catheter inserted. You may be given a sedative and will receive general anesthesia unless your surgeon feels your surgery requires you to be awake during the procedure (also known as an awake craniotomy). The anesthesiologist will monitor your heart rate, blood pressure, breathing and blood oxygen during the surgery.

The location and size of the tumor will determine the type of craniotomy performed, and the area where the incision is made and the bone removed. A special computer navigation system may be used to guide your surgeon to the exact location of the tumor. This system allows for a smaller opening in the skull and a safer outcome. Your head will be placed in a device to hold you still during the surgery, and removed once the surgery is complete. Your scalp will be pulled away from the incision site and clipped to control bleeding. A medical drill and special bone saw may then be used to carefully remove a small area of bone without damaging the tissue below. The bone that is removed will be saved for reinsertion at the end of surgery, or in a follow-up surgery if swelling needs to be reduced.

The membrane that covers the brain, called the dura mater, will be separated from the bone and carefully cut open to expose the brain. Excess fluid will then be drained, and the surgeon will begin the process of exposing and removing the tumor. Samples may be sent to the lab for testing, and drains or pressure monitoring devices may be placed in the skull.

Once the surgeon has removed as much of the tumor as is safely possible, the layers of tissue are then stitched back together. If the bone is to be reattached, it is held in place using plates, sutures or wires, and the skin is then closed with sutures or staples. Depending on the size, type and location of the tumor, this procedure can take anywhere from approximately two to six hours.

Recovery

Your recovery process will vary depending upon the type of procedure done and the type of anesthesia given. The typical hospital stay for a craniotomy procedure is three to seven days, though more complex procedures, or procedures in certain areas of the brain, may require a longer stay.

Once you are stable after the surgery, you will be in a recovery room for observation and then moved to the intensive care unit or to your hospital room. Depending upon the type of craniotomy, you may be given medication to decrease brain swelling and oxygen to help with breathing. You will be checked often to test your brain function and strength and medical staff will help you with activities like breathing exercises and special exercises for your arms and legs.

The urinary catheter may remain for a day or so, until you are able to move around and go to the bathroom on your own. A sequential compression device (SCD) may be put on one of your legs, which will slowly pump air into and out of fitted sleeves while you are in bed to prevent blood clots.

Estimated Recovery Timeline

The total recovery time may vary greatly depending on the size and location of the tumor, and functions impacted, but it will typically take two to three weeks to regain your strength.

You may be discharged from the hospital to a rehabilitation facility for a short period to help you regain your strength. Once at home, it is important to keep your incision clean and dry. You doctor will give you specific bathing instructions. Your incision and head may ache, especially with deep breathing, coughing and exertion. Take pain relievers as recommended by your doctor, continue your breathing and physical therapy exercises, and avoid respiratory infections and irritants such as tobacco smoke. Avoid heavy lifting and driving until told by your doctor you may resume theses activities.

Craniotomy Possible Risks

Many of the risks of performing a craniotomy to remove a tumor depend on the location of the tumor and the difficulty in removing it. These types of risks include memory, balance, speech, hearing, vision and motor problems, but not removing the tumor also carries similar risks. Other risks from craniotomy surgery include:

• Bleeding
• Blood clots
• Blood pressure instability
• Brain swelling
• Infection
• Pneumonia
• Seizures
• Spinal fluid leakage
• Stroke
• Paralysis
• Coma