craniotomy surgery

craniotomy surgery in Iran

What are the types of Craniotomy?

What happens during surgery?

Is a craniotomy a serious surgery?

Is a craniotomy considered brain surgery?

Does the skull heal after a craniotomy?

What is the difference between a craniotomy and a craniectomy?


Craniotomy surgery 

A craniotomy is the surgical removal of part of the bone from the skull to expose the brain for surgery. The surgeon uses special tools to remove the section of bone (the bone flap). After the brain surgery, the surgeon replaces the bone flap and attaches it to the surrounding bone with small titanium plates and screws. If part of the skull bone is removed and not replaced right away, it is called craniectomy. This is done if swelling is likely after brain surgery or if the skull bone flap can't be replaced for other reasons. After a few weeks to months, you may have a follow-up surgery called a cranioplasty. During a cranioplasty, the missing piece of skull will be replaced with your original bone, a metal plate, or a synthetic material.

For some craniotomy procedures, doctors use MRI or CT scans. Imaging helps guide the doctor to the exact place in the brain that is to be treated. When computers and imaging are combined to make 3-D pictures, it called image-guided craniotomy or stereotactic craniotomy.

A craniotomy can be done with various tools that help the surgeon see the area of the brain. These include loupes, a microscope, high-definition cameras, or an endoscope.  A craniotomy with an endoscope involves putting a lighted scope with a camera into the brain through a small hole in the skull.


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What are the types of Craniotomy?

Extended Bifrontal Craniotomy

The extended bifrontal craniotomy is a traditional skull base approach used to target difficult tumors toward the front of the brain. It is based on the concept that it is safer to remove extra bone than to unnecessarily manipulate the brain.

The extended bifrontal craniotomy involves making an incision in the scalp behind the hairline and removing the bone that forms the contour of the orbits and the forehead. This bone is replaced at the end of surgery. Temporarily removing this bone allows surgeons to work in the space between and right behind the eyes without having to unnecessarily manipulate the brain.


Minimally Invasive Supra-Orbital “Eyebrow” Craniotomy

Supra-orbital craniotomy (often called "eyebrow" craniotomy) is a procedure used to remove brain tumors. In this procedure, neurosurgeons make a small incision within the eyebrow to access tumors in the front of the brain or pituitary tumors . This approach is used instead of endonasal endoscopic surgery when a tumor is very large or close to the optic nerves or vital arteries.

Retro-Sigmoid “Keyhole” Craniotomy

Retro-sigmoid craniotomy (often called "keyhole" craniotomy) is a minimally-invasive surgical procedure performed to remove brain tumors. This procedure allows for the removal of skull base tumors through a small incision behind the ear, providing access to the cerebellum and brainstem. Neurosurgeons may use this approach to reach certain tumors, such as meningiomas and acoustic neuromas (vestibular schwannomas).

Orbitozygomatic Craniotomy

The orbitozygomatic craniotomy is a traditional skull base approach used to target difficult tumors and aneurysms. It is based on the concept that it is safer to remove extra bone than to unnecessarily manipulate the brain.

Translabyrinthine Craniotomy

A translabyrinthine craniotomy is a procedure that involves making an incision in the scalp behind the ear, then removing the mastoid bone and some of the inner ear bone (specifically, the semicircular canals which contain receptors for balance). The surgeon then finds and removes the tumor, or as much of the tumor as possible without risk of severe damage to the brain.


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Before the craniotomy surgery

  • Tell your doctor of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. It may be necessary for you to stop these medicines before the procedure.
  • If you smoke, you should stop smoking as soon as possible before the procedure to improve your chances for a successful recovery from surgery and to improve your overall health status.
  • You may be asked to wash your hair with a special antiseptic shampoo the night before the surgery.
  • You may receive a sedative before the procedure to help you relax.
  • The areas around the surgical site will be shaved.
  • Based on your medical condition, your doctor may request other specific preparation.



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What happens during surgery?

Depending on the underlying problem being treated, the surgery can take 3 to 5 hours or longer.

Step 1: prepare the patient
You will lie on the operating table and be given general anesthesia. Once you are asleep, your head is placed in a 3-pin skull fixation device that attaches to the table and holds your head absolutely still during surgery. A brain-relaxing drug called mannitol may be given.

If image-guidance is used, your head will be registered with the infrared cameras to correlate the “real patient” to the 3D computer model created from your MRI scans. The system functions as a GPS to help plan the craniotomy and locate the lesion. Instruments are detected by the cameras and displayed on the computer model.

Step 2: make a skin incision
The incision area of the scalp is prepped with an antiseptic. Skin incisions are usually made behind the hairline. A hair sparing technique is used, where only a 1/4-inch wide area along the proposed incision is shaved. Sometimes the entire incision area may be shaved.

Step 3: perform a craniotomy, open the skull
The skin and muscles are lifted off the bone and folded back. Next, small burr holes are made in the skull with a drill. The burr holes allow entrance of a special saw called a craniotome. Similar to using a jigsaw, the surgeon cuts an outline of a bone window. The cut bone flap is lifted and removed to expose the protective covering of the brain called the dura. The bone flap is safely set aside and will be replaced at the end of the surgery.

Step 4: expose the brain
The dura is opened to expose the brain. Retractors may be used to gently open a corridor between the brain and skull. Neurosurgeons use magnification glasses, called loupes, or an operating microscope to see the delicate nerves and vessels.

Step 5: correct the problem
Enclosed inside the bony skull, the brain cannot be easily moved aside to access and repair problems. Neurosurgeons use a variety of very small instruments to work deep inside the brain. These include long-handled scissors, dissectors and drills, lasers, and ultrasonic aspirators (uses a fine jet of water to break up tumors and suction up the pieces). In some cases, evoked potential monitoring is used to stimulate specific cranial nerves while the response is monitored in the brain. This is done to preserve function of the nerve during surgery.

Step 6: close the craniotomy
After the problem has been removed or repaired, any retractors are removed, and the dura is closed with sutures. The bone flap is put back in its original position and secured to the skull with titanium plates and screws. The plates and screws remain permanently to support the area, and they sometimes can be felt under your skin. A drain may be placed under the skin for a couple of days to remove blood or fluid from the area. The muscles and skin are sutured back together. A soft adhesive dressing is placed over the incision.


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Craniotomy Aftercare and recovery

You will be given a follow-up appointment 10 to 14 days after surgery. The recovery time varies from 1 to 4 weeks depending on the underlying disease being treated and your general health. Full recovery may take up to 8 weeks. Walking is a good way to begin increasing your activity level. Do not overextend yourself, especially if you are continuing treatment with radiation or chemotherapy. Ask your surgeon when you can expect to return to work.

You will be transferred to the recovery area for approximately one hour and then to the neurosurgery ward where observations will be performed regularly. These will include an assessment of your conscious level, examination of your pupil responses, tests of your limb strength and checks on your pulse, blood pressure and respirations.

You may have some headaches, which will lessen with time, and you will feel tired and need to rest at home. If you are taking steroids, the dose will slowly be reduced, as prescribed by your surgeon.


Risks of the craniotomy surgery

As with any surgical procedure, complications may occur. Brain surgery risk is tied to the specific location in the brain that the operation will affect. For example, if the area of the brain that controls speech is operated on, then speech may be affected. Some more general complications include, but are not limited to, the following:

  • Infection
  • Bleeding
  • Blood clots
  • Pneumonia (infection of the lungs)
  • Unstable blood pressure
  • Seizures
  • Muscle weakness
  • Brain swelling
  • Leakage of cerebrospinal fluid (the fluid that surrounds and cushions the brain)
  • Risks associated with the use of general anesthesia



Is a craniotomy a serious surgery?

No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Specific complications related to a craniotomy may include stroke, seizures, swelling of the brain, nerve damage, CSF leak, and loss of some mental functions. Craniotomy, like any surgical operation, carries its particular risks. Craniotomy is primarily a means to an end, so the seriousness of complications may depend mostly on the location on the brain and the type of surgery performed. Despite potential complications, a craniotomy may save lives, and individuals with no other pre-existing conditions are likely to recover fully with good care and treatment.


Is a craniotomy considered brain surgery?

Craniotomy, a procedure typically performed under general anesthesia, involves the surgical removal of part of the skull. Specialized tools are used to remove the section of bone called the bone flap. The bone flap is temporarily removed, then replaced after the brain surgery has been done.

Does the skull heal after a craniotomy?

It can take 4 to 8 weeks to recover from surgery. Your cuts (incisions) may be sore for about 5 days after surgery. You may also have numbness and shooting pains near your wound, or swelling and bruising around your eyes. As your wound starts to heal, it may begin to itch.


What is the difference between a craniotomy and a craniectomy?

A craniotomy is a surgical procedure that may be used to treat brain cancer. A craniectomy is a similar procedure that involves a different surgical technique and is used in different situations. Craniectomy is neurosurgical procedure that involves removing a portion of the skull in order to relieve pressure on the underlying brain.


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10 common questions about craniotomy surgery in Iran

1Is craniotomy a major surgery?
A craniotomy is surgery to open your skull to fix a problem in your brain. It can be done for many reasons. For example, you may need a craniotomy if your brain or blood vessels are damaged or if you have a tumour or an infection in your brain. You will probably feel very tired for several weeks after surgery
2Why would a craniotomy be performed?
Craniotomy is a surgery to cut a bony opening in the skull. A section of the skull, called a bone flap, is removed to access the brain underneath. ... It may be performed to treat brain tumors, hematomas (blood clots), aneurysms or AVMs, traumatic head injury, foreign objects (bullets), swelling of the brain, or infection.
3How painful is a craniotomy?
Chronic Pain following Craniotomy Clinically persistent headache after craniotomy is characterized as a combination of tension type and “site of injury” headache overlying the surgical site. It can be sharp aching, pressurising, or throbbing. The surgical technique too seems to have a bearing on the postoperative pain.
4Does skull grow back after craniotomy?
Usually, only a small area of your head will be shaved. You are unlikely to have your whole head shaved. After the operation, your hair will grow back where it has been shaved. Once the wound on your head has healed, and your stitches or clips have been removed, you can wash your hair and use hair products as usual.
5What procedure requires a craniotomy?
Craniotomy, a procedure typically performed under general anesthesia, involves the surgical removal of part of the skull. “During this procedure, we remove part of the bone from the skull that's referred to as the 'bone flap',” says Dr. Modha
6How long after a craniotomy can you drive?
You can usually drive again after you have recovered from treatment for a pituitary tumour. If you have a craniotomy (instead of transphenoidal surgery) you can't drive for 6 months
7How is skull reattached after brain surgery?
After the brain surgery, the surgeon replaces the bone flap and attaches it to the surrounding bone with small titanium plates and screws. If part of the skull bone is removed and not replaced right away, it is called craniectomy
8Do they shave your head for a craniotomy?
If you do need to have your hair shaved, you might have part of your head shaved, or the whole head. This is usually done when you're under anaesthetic in the operating room. ... For tumours in the brainstem or back part of the brain (cerebellum), your surgeon might only need to shave a small area at the back of your head.
9How long does fatigue last after brain surgery?
While there is not a cure for fatigue, it can be helpful to remember that for many people fatigue usually improves after treatment has ended (usually within six months to one year). However, within that time it can be debilitating and some people do continue to experience it for longer
10How long do headaches last after a craniotomy?
A headache has resolved within 3 months after the craniotomy. A headache has not yet resolved but 3 months have not yet passed since the craniotomy


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