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Last updated May 4, 2018

Approved by: Maulik P. Purohit MD, MPH

Craniotomy is a surgical procedure that involves opening a small portion of the cranium (bony structure around the brain and part of the skull) temporarily in order to treat diseases or disorders of the brain.

Background Information:

What are the other Names for the Procedure?

  • Craniectomy
  • Stereotactic Brain Biopsy
  • Stereotactic Craniotomy

What is Craniotomy surgical procedure?

Craniotomy is a surgical procedure that involves opening a small portion of the cranium (bony structure around the brain and part of the skull) temporarily in order to treat diseases or disorders of the brain.

What part of the Body does the Procedure involve?

A Craniotomy procedure involves the scalp, cranium, brain membrane, and the brain.

Why is the Craniotomy surgical procedure Performed?

There could be various reasons for performing a Craniotomy surgical procedure. Some of these are:

  • Brain tumors
  • To remove aneurysms or blood clots (hematomas)
  • Brain hemorrhage
  • Drainage of brain abscess
  • Damage, injury, or tear, in the brain membrane
  • Skull or cranium fracture
  • To relieve pressure in the brain after injury

What are some Alternative Choices for the Procedure?

To treat any ailment related to the brain, a Craniotomy surgical procedure remains the gold standard technique.

What are the Recent Advances in the Procedure?

A recent advancement in the procedure is known as Awake Craniotomy.

What is the Cost of performing the Craniotomy surgical procedure?

The cost of Craniotomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Craniotomy procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.surgeryencyclopedia.com/Ce-Fi/Craniotomy.html#b (accessed on 24th July, 2012)

http://www.nlm.nih.gov/medlineplus/ency/article/003018.htm (accessed on 24th July, 2012)

http://www.neurosurgery.com.au/pdfs/postop/postopcranipdf.pdf (accessed on 24th July, 2012)

http://neurosurgery.ucla.edu/body.cfm?id=410 (accessed on 24th July, 2012)

Prior to Craniotomy surgical procedure:

How is the Craniotomy surgical procedure Performed?

  • Before the surgery, the area in and around the part where the problem is suspected to lie, is shaved (of hair)
  • The surgeon makes an incision on the scalp and cuts a portion of the cranium which is kept aside in a sterile place
  • The diseased or problem area is located in the brain and treated
  • Next, the cut portion of the cranium is repositioned and the scalp closed with sutures or clips, which can be removed after a week (or as advised by the physician)

Where is the Procedure Performed?

A Craniotomy procedure is performed in a hospital. The individual is admitted, undergoes the procedure and discharged, as per the physician’s instruction.

Who Performs the Procedure?

A Craniotomy procedure is performed by a neurosurgeon, along with an anesthesiologist.

How long will the Procedure take?

The time for the procedure depends on the reason for performing the procedure. It may take anywhere between 2-5 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anesthesia is not used; however, do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Craniotomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Craniotomy surgical procedure?

The individual has to undergo certain tests prior to a Craniotomy procedure, such as:

  • Routine blood and urine analysis
  • X-ray
  • MRI
  • CT scan
  • Arteriogram
  • Angiogram
  • EEG or ECG

The physician may suggest further tests depending on the health of the individual and their medical history. Do note that sometimes, only a few of the above mentioned tests, or all of the tests may have to be taken.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Craniotomy procedure?
  • Why is this procedure necessary? 
  • What does the procedure involve?
  • How will this procedure help?
  • Will it affect me or the normal functioning of the brain in any way?
  • Will it leave a permanent scar on the scalp?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • How many such procedures have you (the physician) performed?
  • What are the costs involved? 

During the Craniotomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure, the individual is administered general anesthesia.

How much Blood will you lose, during the Procedure?

Craniotomy is a delicate and complex surgery; there could be a considerable loss of blood involved, depending on the particular nature of the problem. In such cases, a blood transfusion is immediately performed.

What are the possible Risks and Complications during the Craniotomy surgical procedure?

The possible risks or complications that may arise during the surgery are as follows:

  • Excessive bleeding
  • Infection
  • Accidental injury to the neighboring tissue or bone
  • Blood clot formation
  • Stroke
  • Coma

What Post-Operative Care is needed at the Healthcare Facility after the Craniotomy surgical procedure?

The healthcare facility must have an intensive care unit (ICU), where the patient may recover post-surgery. Apart from this no particular care is needed, unless any complications arise.

After the Craniotomy surgical procedure:

What are the possible Risks and Complications after the Craniotomy surgical procedure?

Post Craniotomy surgical procedure, the following complications may arise:

  • Infection in the surgical wound
  • Swelling in the brain
  • Problems in speech, vision, balance, co-ordination, or other functions, depending on the part of the brain involved in the surgery
  • Seizures
  • Hemorrhage

What is the Prognosis after the Surgery?

The prognosis from the procedure is usually good. But, it largely depends on the extent and complexity of the problem faced by the individual, their age, and overall health status.

When do you need to call your Physician?

Do contact your surgeon/physician if you notice any of the following symptoms:

  • Pain around the surgical wound
  • Swelling and redness
  • Swelling in the legs
  • Bleeding or drainage
  • Increased severity in headaches
  • Seizers or fits
  • Problems in speech, vision disturbance
  • Paralysis of the face, hands, or legs
  • Dizziness
  • Muscle ache
  • Nausea or vomiting
  • Signs of infection
  • If any new symptom or discomfort is observed

What Post-Operative Care is needed at Home after the Craniotomy surgical procedure?

At home, the following post-operative care is recommended, post Craniotomy procedure:

  • Complete the course of medication
  • Elevate your feet while resting
  • Use warm compress to relieve incisional pain
  • Take stool softeners
  • Avoid strenuous exercises
  • Keep the incision site clean and dry
  • Wash the incision site with mild soap, while bathing
  • Resume daily activity only after you feel better
  • Avoid non-prescription medications or pain killers
  • Refrain from sex, until advised otherwise by your physician
  • Avoid taking non-prescribed medications

How long does it normally take to fully recover, from the Procedure?

It takes about 6-8 weeks to fully recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and is later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Craniotomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital
  • The neurosurgeon
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Craniotomy procedure is performed. 

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 4, 2013
Last updated: May 4, 2018