A craniotomy is a procedure to remove a lesion in the brain through an opening in the skull (cranium).
A craniotomy is a type of brain surgery. It is the most commonly performed surgery for brain tumor removal . It also may be done to remove a blood clot (hematoma), to control hemorrhage from a weak, leaking blood vessel (cerebral aneurysm), to repair arteriovenous malformations (abnormal connections of blood vessels), to drain a brain abscess, to relieve pressure inside the skull, to perform a biopsy, or to inspect the brain.
Because craniotomy is a procedure that is utilized for several conditions and diseases, statistical information for the procedure itself is not available. However, because craniotomy is most commonly performed to remove a brain tumor, statistics concerning this condition are given. Approximately 90% of primary brain cancers occur in adults, more commonly in males between 55 and 65 years of age. Tumors in children peak between the ages of three and 12. Brain tumors are presently the most common cancer in children (four out of 100,000).
There are two methods commonly utilized by surgeons to open the skull. Either an incision is made at the nape of the neck around the bone at the back (occipital bone) or a curving incision is made in front of the ear that arches above the eye. The incision penetrates as far as the thin membrane covering the skull bone. During skin incision the surgeon must seal off many small blood vessels because the scalp has a rich blood supply.
The scalp tissue is then folded back to expose the bone. Using a high-speed drill, the surgeon drills a pattern of holes through the cranium (skull) and uses a fine wire saw to connect the holes until a segment of bone (bone flap) can be removed. This gives the surgeon access to the inside of the skill and allows him to proceed with surgery inside the brain. After removal of the internal brain lesion or other procedure is completed, the bone is replaced and secured into position with soft wire. Membranes, muscle, and skin are sutured into position. If the lesion is an aneurysm, the affected artery is sealed at the leak. If there is a tumor, as much of it as possible is resected (removed). For arteriovenous malformations, the abnormality is clipped and the repair redirects the blood flow to normal vessels.
Since the lesion is in the brain, the surgeon uses imaging studies to definitively identify it. Neuroimaging is usually accomplished by the following:
Before surgery the patient may be given medication to ease anxiety and to decrease the risk of seizures, swelling, and infection after surgery. Blood thinners (Coumadin, heparin, aspirin ) and nonsteroidal anti-inflammatory drugs (ibuprofen, Motrin, Advil, aspirin, Naprosyn, Daypro) have been correlated with an increase in blood clot formation after surgery. These medications must be discontinued at least seven days before the surgery to reverse any blood thinning effects. Additionally, the surgeon will order routine or special laboratory tests as needed. The patient should not eat or drink after midnight the day of surgery. The patient's scalp is shaved in the operating room just before the surgery begins.
Craniotomy is a major surgical procedure performed under general anesthesia. Immediately after surgery, the pa tient's pupil reactions are tested, mental status is assessed after anesthesia, and movement of the limbs (arms/legs) is evaluated. Shortly after surgery, breathing exercises are started to clear the lungs. Typically, after surgery patients are given medications to control pain, swelling, and seizures. Codeine may be prescribed to relive headache. Special leg stockings are used to prevent blood clot formation after surgery. Patients can usually get out of bed in about a day after surgery and usually are hospitalized for five to 14 days after surgery. The bandages on the skull are be removed and replaced regularly. The sutures closing the scalp are removed by the surgeon, but the soft wires used to reattach the portion of the skull that was removed are permanent and require no further attention. Patients should keep the scalp dry until the sutures are removed. If required (depending on area of brain involved), occupational therapists and physical therapist assess the patient's status postoperatively and help the patient improve strength, daily living skills and capabilities, and speech. Full recovery may take up to two months, since it is common for patients to feel fatigued for up to eight weeks after surgery.
The surgeon will discuss potential risks associated with the procedure. Neurosurgical procedures may result in bleeding, blood clots, retention of fluid causing swelling (edema), or unintended injury to normal nerve tissues. Some patients may develop infections. Damage to normal brain tissue may cause damage to an area and subsequent loss of brain function. Loss of function in specific areas can cause memory impairment. Some other examples of potential damage that may result from this procedure include deafness, double vision, numbness, paralysis, blindness, or loss of the sense of smell.
Normal results depend on the cause for surgery and the patient's overall health status and age. If the operation was successful and uncomplicated recovery is quick, since there is a rich blood supply to the area. Recovery could take up to eight weeks, but patients are usually fully functioning in less time.
There is no information about the rates of diseases and death specifically related to craniotomy. The operation is performed as a neurosurgical intervention for several different diseases and conditions.
There are no alternative treatments if a neurosurgeon deems this procedure as necessary.
Connolly, E. Sanders, ed. Fundamentals of Operative Techniques in Neurosurgery. New York: Thieme Medical Publishers, 2002.
Greenberg, Mark S. Handbook of Neurosurgery. 5th ed. New York: Thieme Medical Publishers, 2000.
Miller, R. Anesthesia. 5th ed. Philadelphia, PA: Churchill Livingstone, 2000.
Gebel, J. M., and W. J. Powers. "Emergency Craniotomy for Intracerebral Hemorrhage: When Doesn't It Help and Does It Ever Help?" Neurology 58 (May 14, 2002): 1325-1326.
Mamminen, P., and T. K. Tan. "Postoperative Nausea and Vomiting After Craniotomy for Tumor Surgery: A Comparison Between Awake Craniotomy and General Anesthesia." Journal of Clinical Anesthesia 14 (June 2002): 279-283.
Osguthorpe, J. D., and S. Patel, eds. "Skull Base Tumor Surgery." Otolaryngologic Clinics of North America 34 (December 2001).
Rabinstein, A. A., J. L. Atkinson, and E. F. M. Wijdicks. "Emergency Craniotomy in Patients Worsening Due to Expanded Cerebral Hematoma: To What Purpose?" Neurology 58 (May 14, 2002): 1367-1372.
American Association of Neurological Surgeons. 5550 Meadowbrook Drive, Rolling Meadows, IL 60008. (888) 566-AANS (2267). Fax: (847) 378-0600. E-mail: info@aans. org. http://www.neurosurgery.org/aans/index.asp .
Laith Farid Gulli, M.D., M.S.
Nicole Mallory, M.S., PA-C
Robert Ramirez, B.S.
The procedure is performed in a hospital with a neurosurgery department and an intensive care unit . The procedure is performed by a board certified neurosurgeon, who has completed two years of general surgery training and five years of neurosurgical training.
Also, since the craniotomy, I told the neurosurgeons and many doctors about the side effects, but they seemed to have no answers for me, as July, 2007, CT scans of my head and neck showed some changs, but nothing too bad.
However, I had another CT scan of my brain and neck in Feb. 200i which showed some intracranial hemorraghing which has stabilized now, but I still continue to have constant fatigue, nausea, and headaches that are preventing me from working again and from leading a "normal" life, as these side effects occur almost daily.
I am on a strong anti-nausea medication called Zofran, but it doesn't seem to help THAT much, and doesn't help at all with the fatigue. I also am taking Klonopin and Trileptal, but the headaches continue. They are NOT migraine headaches, just constant headaches on the side of the head where the craniotomy was and where the main jaw muscle was cut. Most likely the headaches and nausea contribute to the fatigue.....is that correct?
I am writing this to you on May 21, 2008, so it has been one and a half years since my craniotomy and the hemorraging occurred between July, 2007, and Feb. 2008 when I had two brain and neck CT scans that showed the intracranial hemorraghing, but that seems to have stopped.
Will the fatigue, headaches, and nausea continue? Is there something that can be done to help me so I can function better?
I do try to exercise walk as much as possible, but when I do, I really need to rest and sometimes sleep for hours afterward. Walking was my exercise of choice since 1987 so I am dismayed that it is so hard for me to do now without feeling great, as before the craniotomy, but worse on most of the days that I take long walks with my dogs in an "off-leash" park so I can swing my arms and really walk without having to stop many times as the dogs stop to sniff and "do their stuff", so to say!
Thank you in advance for any advice that you can give to me. I will be more than willing to try ANYTHING to help me to improve my functioning, as I was always an active woman.
I taught junior high school for 30 years, loved it, and never was as tired as I am now, even when I had little sleep on many days correcting papers, taking care of my child, etc.
I am 60 years old now, but when people first meet me, they think I am in my 40s. (no plastic surgery, just the laughing and all the physical activity that went with teaching adoloescents for so many years makes a person look younger, I guess!)
Please, please help me! I will try ANYTHING you suggest to help myself get better.
YOU HAVE TO TAKE BABY STEPS. seizures can cause a fall and a rebleed.
Thank you, in help is welcome
the only think i want to no is when is fluid going to go down. because of pressure i still have another one they are going to coil on brain stem when is the pain gonna stop? meds don't stop it,
does it get any better i feel im in more pain now
i would like to know y the paining is still there to him is there is any risk to him..
I'm 33 years old and suffered from simple/complex partial seizures. I'm very active in a gym and at running sports and have always been mobile. My recovery period seems to be good when in the gym and I'm on a steady slow build up on activities. But I haven't started running yet and I'm waiting until oct to see neuro surgeon to get a pass to play soccer again. I'm suffering from a tiredness when I've had to concentrate and I'm constantly having rests but my sleep pattern at night is difficult to take as it seems to get past midnight before I can even try to shut down and sleep.
I'm just wondering how the best way would be to start trying to build my strength back up and my fitness along with coping with building my mental strength up too
please answer my question, i really need it...thanks so much before
in Massachusetts world known for itsmedical. The neuro surgeon's. Said it wad the largest they had seen. I was about 33 going on 34 and, I'm now 40. Right after the surgery I thought everything was OK. Little did I know life as I knew it was gone. I was a nurse for 10 years prior. At the time. I had an 18 month daughter,and two tweens . I guesses its been 7 years know. I became an epileptic and have had several seizures since. About3 years ago I had one, and ended up back in the hospital with a skull fracture. I'm depressed all the time since the right frontal lobe is where emotions come from. I have chronic pain the headaches don't go away there not migraines. I have chronic fatigue. But through the brain injury association there's one in in every state. I'm learning that this is all normal every traumatic.brain injury is different. Thru support groups I'm learning life will never be the same for me,but I need to play the cards dealt to me. If anyone would like information on support groups and how to find them please email me at bethanyfaith71@ Gmail. Com. I hope my message reaches out to at lest one person. God bless,and keep bethanyfaith
I had an accident (falling off a golf cart a co-workers was driving too fast) onto the concrete. I had an epidural hematoma and hence the craniotomy.
Nausea did occur for me for about 4 weeks. Every time my mother would assist me in sitting up in bed, I would fall over and she assisted me in walking to the bathroom. I heard nauseau is common due to the fact that one side of your brain was operated on, so it messed with your equalibrium. Mine went away after a month. Perhaps persistent nauseau is from a medication?
I had my surgery September of 2007. To this day, I can still have some pain on the side of the fall/surgery where there is a dent (my hair hides this) and I can feel little bone spurs or something like that. The pain isn't tremendous but continues 4 years later. If I sleep too long on that side of my head, it will start to hurt. The neurologists try to tell me it's scar tissue which I find it hard to believe after 4 years.
The truth of the matter is that many neurologists don't know the answers to questions. They'll tell you the brain is the most complex organ in the body...true. Right now, I've had a movement disorder come back (they still don't know what to call it...perhaps myoclonus but they're not sure) after being free from it on medicine for 3 years. It has gotten worse. Watch out for Klonopin. It can help people, but it's also a benzo (like alcohol) and your body gets addicted to it as it is stored in your fat cells. If a doctor doesn't wean you off properly (i.e., in a very slow methodical way), you end up detoxing which is awful.
I don't know that anyone can "come back" completely from a craniotomy--it's serious brain surgery.
All I can say is like one person said on this post is that we have to grateful to be alive. Keep pushing your doctors or find one that thinks outside the box and can give you answers or at least mitigate your symptoms. Good luck to all and Happy Holidays.
She had made a remarkable recovery and was walking and talking normal although her memory was a little cloudy still but over time was getting back to normal.
However during her initial scans the doctors found a 3rd aneurysm of 8mm on the opposite side of the brain and that when she was well enough that she would have to go back in and have that clipped.
She recovered so well after her first operation that she was well enough to have the second operation at the end of March 2012, she had a nine hour operation which went very well and an hour after the operation she was talking and joking with me for about an hour or so in ICU.
She was released 5 days later from hospital and was great, the staples had just been removed and we had to wait a further 5 days for the stitches to be removed by her local GP. And this is where the sad part comes in.
The day her stitches were removed her whole personality changed and she did not want to know me anymore, all she did was get angry at me and wanted me out of her life, for some reason her mind kept telling her that I was a liar a cheat and that I was never at the hospital for her etc etc and because we didn't live together, although I stayed at her place after the first operation for around 3 months so I could cook for her clean for her and look after her cat and her son who is nearly blind, I ran myself to the ground for her and her family and now I have nothing to show for giving her so much love and care and for being the only one that was there for her though this horrible time she went through, she will not take my calls and when she does she is just nasty and screams at me.
She now is moving this week far away down the south coast and there is nothing I can do to stop it or be there for her if something goes wrong. The son that lives with her is so stupid that he just goes along with whatever she says so now he hates me even after all I did for him whilst she was in hospital and the same goes for her mother that Linda was not talking to at all , but now she has come on the scene and she has been controlling Linda and she is the reason the love of my life is moving because her mum has talked her into moving down where she lives.
This all seems so cruel and unfair because the son and her mother are making her do things that Linda would not normally be doing, we were best mates and so much in love that all day and night I just feel numb and the reality of this still has not sunk in.
So even though the operations were good the overall result was a disaster bgut the neuro surgeon wioed his hands of it and then wouldn't talk to me citing the privacy act
It is my opinion that the surgeon was instrumental in my recovery.
My thoughts and prayers go out to all who may need a procedure of this type. I hope you all have a surgeon as capable as the one Ihad.
Looking forward to getting back to work.
With the TBI, I find that my short term memory has been affected and extended analytical work is overly tiring(although I am now 58 yoa, which may be contributing to these conditions). I believe my wife divorced me because she thought I wouldn't have my faculties post surgery/rehab. Now, I am developing a startup company to prove out the old adage; The best revenge is success. It wasn't my time in 2008 and I must have more work to do, as I wouldn't be here 5 years later. Thanks for listening, Dave
The issue we are having with him is that he is refusing medical treatment to have the cranioplasty and sinus reconstructive surgery done. He says itâ€™s his body, heâ€™s 21 and therefore NO MEDICAL professional will cross his will by making him take his meds, going to have CT scans, etc. He HATES wearing his helmet to protect his missing skull noggin. We have been advised by an attorney because he can cognitively answer all the questions correctly that he is â€œcompetentâ€ and therefore no judge will grant us guardianship, however he is declared a risk to himself and to others and so has to remain in a skilled nursing facility. The rehab center wonâ€™t take him until his noggin is back in one piece, , ,
Weâ€™ve hit a brick wall and have tried all sorts of avenues to no avail, so I thought maybe one of you has had this experience. Any help or suggestions would be GREATLY appreciated.
FIGHT for the correct digonosis and information.
All l can quote is life is what you make it cause you don't know what you got until it's suddenly disappeared forever!!
where after a few hours she was walking around quiet normally.but in considerable pain.i was amazed how quickly she was on her feet. so far so good. she went for mri scan on the 2nd. waiting for doctor to let us know what happens next.(03/03/17)
Sometime between 9 and 11 months of age in 1955, I underwent surgery for, what I had explained to me as "brain tumors" on both sides of my head. Later, my Mother used the term Bone Flaps to describe the Horseshoe like scars on both sides of my head as evidence of the operations.
My Mother has passed sometime ago, and for what ever reason, when I was younger, I just wasn't too curious as to the actual procedure, or to how significant my complete recovery was. As you can deduce, I'm into my sixties, and with the exception of some rare migraines, and scars that preclude my "shaving my head", I have had no physical issues relating to those surgeries.
Reading the preceding comments, I just wanted to lend an optimistic note, for those who have this surgery in front of them.