A craniotomy is an operation in which the skull is temporarily opened in order to access the brain. A craniotomy may be performed for various conditions including brain tumours e.g., gliomas, meningiomas and metastases, cavernomas and bleeding inside the skull or brain.
A craniotomy is usually performed under general anaesthesia, although an awake craniotomy may be performed, with local anaesthesia and sedation instead, if indicated.
Typically, the patient’s head is held firmly in place by a three-pin cranial fixation clamp which is placed on the outer surface of the skull. Dr Laban uses computer neuro-navigation, which provides real-time intra-operative image guidance, to precisely locate the affected area of the brain. The size, location and the shape of the incision will vary depending on the underlying problem. Once the line of incision is determined, the patient’s hair is shaved along that line. An incision is made in the scalp and the skin is folded back to expose the skull. A high-speed precision surgical drill is used to make small burr holes in the skull and cut the disc of bone (a bone flap) which is then removed and kept sterile.
The membranes covering the brain can then be opened to expose the brain. If the affected area is on the surface of the brain it will be carefully separated from the brain and removed. If the affected area is inside the brain, a small precise incision is made in the surface of the brain (corticotomy) to allow safe access to the affected area of the brain. Dr Laban uses state-of-the-art operating microscopes to increase accuracy, reduce complications and improve safety.
At the end of the procedure the membrane layer covering the brain is closed, sometimes using an absorbable collagen matrix graft. The bone flap is replaced and secured with small metal plates and screws. The scalp incision is then closed with sutures or with surgical staples.
Occasionally (e.g. because of tumour involving the bone or, more rarely, because of brain swelling) the bone flap is not replaced during the initial operation. This is known as a craniectomy. A second operation known as a cranioplasty may be required to close this skull defect. Cranioplasty implants may be made of acrylic, polyethylene or titanium.
Post Procedure
Typically, following surgery, patients can eat and drink and move around independently as safe. Usually, patients are in hospital for three to five days depending on the complexity of surgery. Surgical staples are removed one to two weeks following surgery depending on the site of surgery and whether there has been previous surgery at the same site. You can wash your hair two days after the operation. You should avoid dyeing your hair for three months.
Austroads guidelines state “a person should not drive for six months following supratentorial surgery or retraction of the cerebral hemispheres” for private drivers and “twelve months” for commercial drivers. This will apply to most patients who have had a craniotomy. https://austroads.com.au/drivers-and-vehicles/assessing-fitness-to-drive
Risks
All operations carry some risk. The risks of craniotomy include scarring, numbness around the site of the scalp incision, headaches, bleeding, infection, CSF leak or CSF disturbance, epilepsy, stroke and neurological deficit (including visual / hearing / balance / speech / swallowing / sensory / cognitive disturbance or loss, weakness and paralysis), pain, hormone disturbance (with need for long term replacement), death, symptoms remaining the same, increasing or recurring, the need for further procedures, venous thromboembolism, cardiorespiratory complications and general anaesthetic risks.