Types of craniotomy
Craniotomies are of various types depending on the name of the technique or the location of the surgery:
- Stereotactic craniotomy- This type of craniotomy involves the use of an MRI or a CT scan. Your doctor will use imaging tests for creating 3-D images of your brain that will allow them to differentiate between healthy tissue and normal tissue. The technique helps to figure out the best spot for an incision on the scalp and easily make smaller cuts for performing minimally invasive procedures.
- Endoscopic craniotomy- Your doctor will make a small cut into your skull and insert an endoscope (small lighted device) with a camera.
- Keyhole craniotomy: Meant for removing brain tumors, it is a minimally invasive procedure. It has a shorter recovery time and causes less scarring. Your doctor will make a small incision behind the ear for removing the brain tumor.
- Awake craniotomy- You will stay awake during this surgery as your doctor asks you some questions for monitoring the activity of your brain. He or she will observe which parts of your brain are involved in vision, speech, and movement to about them at the time of the surgery.
- Supra-orbital eyebrow craniotomy- This procedure helps to remove brain tumors present in your front brain by allowing your surgeon to make a small incision in your eyebrows. It causes minimal scars as it is a minimally invasive approach.
- Frontotemporal or Pteronial craniotomy- The frontal, temporal, parietal, and the sphenoid bones meet at the pterion in the skull. The pterion is located near your temple on the side of the skull. The procedure involves the removal of a part of the pterion by making an incision behind the hairline. This lets the surgeon gain access to several parts of the brain.
- Orbitozygomatic Craniotomy- It finds its use in treating aneurysms and difficult tumors. Your surgeon will make a small cut behind your hairline and remove a part of the bone temporarily. This creates a curve of your orbit, cheek, or eye socket. Your surgeon will be able to reach deeper areas of your brain and there will be minimal risk of brain damage.
- Posterior fossa craniotomy- If a tumor is present in the posterior fossa of the skull, it may put pressure on the spinal cord, cerebellum, and brainstem. The procedure helps to remove this tumor while alleviating the pressure. Your surgeon will do this by making an incision at your skull base.
- Translabyrinthine craniotomy- It involves an incision behind your ear for removing a part of your mastoid bone & the semicircular canals that help to balance. Your doctor can also remove an acoustic neuroma with this procedure. There is a lower risk of facial nerve damage with this surgery.
- Bifrontal craniotomy- It helps to remove hard tumors present at the front of your brain and when the tumor removal is complex through minimally invasive surgery. Your doctor will make an incision behind the front hairline for removing a piece of bone forming the curve of the forehead. This helps your doctor to gain access to the front of your brain.
Reasons for the procedure
Your doctor will perform the procedure for treating:
- Blood clot
- Tear in the dura mater
- Intracranial pressure
- Cerebral edema or swelling
- Brain abscess
- Arteriovenous malformation
- Bleeding from the skull
- Skull fracture
- Arteriovenous fistula
What to expect?
Before the procedure
Your neurosurgeon may call you for multiple appointments before the surgery and use various tests for confirming if you can undergo the procedure without any risks. These tests may be a physical examination, blood tests, neurological examination, and CT scan or MRI scan. Your surgeon will also be able to determine the site of surgery according to the type of Craniotomy and your medical condition. You will have to start fasting a night before your surgery and wash your hair with an antiseptic shampoo.
During the procedure
The team of doctors will ask you to remove all the jewelry and accessories that you might be wearing and change your clothing with a hospital gown. You will be asked to lie down on the operating table as a device holds your head in place. The staff will insert an IV line into your arms, a urinary catheter into your urinary bladder, and administer general anesthesia to you. When you fall asleep due to anesthesia, your surgeon will shave your hair present at the surgical site and also clean the area for minimal risk of infection.
Your surgeon will cut your scalp while using a drill & saw to remove the bone flap. He or she will incise the dura mater to gain access into your brain and perform the procedure while removing tissue samples, wherever needed. The team of surgeons will stitch the tissues together and replace the bone flap with wires, plates, or stitches. Next, they will apply a sterile bandage after stitching.
The nurses will take you to the recovery unit and monitor your vitals. If they are stable, they will shift you to your hospital room and ask you to stay there for a week. You might need to elevate your head for managing the swelling and will get oxygen for a few days. You will have to perform deep breathing exercises for treating pneumonia and need commission devices on your legs for preventing blood clots. You will wear the catheter for a few days and the team of doctors will check you regularly for the proper functioning of your brain. You may need to take medications and take rest for at least 6 weeks. Additionally, you might need physiotherapy and speech therapy for regaining the normal functions of walking, talking, and strength.
Certain factors are contributing to the risks associated with the Craniotomy procedure including your medical condition. The most common risks of Craniotomy procedure may be:
- Head scarring
- Facial nerve damage
- Muscle weakness
- Dent where the bone flap was removed
- Damage to the sinuses
- Brain swelling
- Injury due to the head device
- Infection of the skin or bone flap
- The leaking of the CSF or the cerebrospinal fluid
- Speech and memory problems
- Coma or paralysis
- Balance issues
- Bleeding or blood clots
- Unstable blood pressure
- Reaction to anesthesia