A craniotomy is a surgical operation in which part of the skull, called a bone flap, is removed in order to access the brain. Craniotomies are necessary for many types of surgery including lesions, Traumatic Brain Injury (TBI) and the implantation of deep brain stimulators for the treatment of Parkinson's, epilepsy and cerebellar tremor.
How Is The Procedure Performed ?
A craniotomy is performed under general anesthesia. This means the person is put to sleep with medication and cannot feel any pain. The hair on part or all of the scalp is shaved. An incision is made in the scalp over the area of the suspected condition or disorder. A flap of the bone is cut away from the skull and set aside during the surgery. The disorder is located and treated. The bone flap is replaced, and the scalp is closed with sutures or clips.
Why Do I Need A Craniotomy ?
The most common reasons for having a craniotomy are a subarachnoid haemorrhage (a bleed over the surface of the brain), a brain tumour (an abnormal growth of cells in the brain), or a serious head injury.
What Happens Before The Operation ?
The surgeon and anaesthetist will ask you about your general health and any medical conditions that could increase the risks of surgery before deciding when to do the operation.
The operation is usually carried out under a general anaesthetic which means you will be asleep throughout and will not feel anything.
A small horseshoe-shaped area of your scalp is shaved over the point at which the surgeon needs to operate.
What Happens During The Operation ?
An incision (cut) is made in the scalp, a skin flap is peeled back, burr holes are drilled in the skull, and then a piece of bone (“bone flap”) is cut out like a trap-door to reveal the brain underneath.
The surgeon then begins work: to close the connection between a blood vessel and an aneurysm with a small clip, to remove all or part of a tumour, to remove a blood clot, or to relieve pressure on the brain.
The bone flap is then replaced and the scalp is stitched together. The bone flap is usually fixed into place with small metal screws to prevent movement and encourage better healing.
The operation takes approximately 4-6 hours. This includes the time to transport you from the ward to the operating theatre, giving you the anaesthetic, the operation itself, and the time you spend recovering from the anaesthetic.
What Happens After The Operation ?
You will usually be woken up as soon as the operation is over. You will regain consciousness in the recovery area where special nurses monitor your progress very closely. Occasionally, intensive monitoring is required, and you might be transferred to an intensive therapy unit or a high dependency unit. You might then be kept asleep on a breathing machine for a period of time after the operation to allow your brain to recover. If this is likely to be necessary, your surgeon will discuss it with you before the operation.
Once you have been transferred back to the ward you will be carefully observed and monitored. You will be given fluids through a drip into your vein. You might also have a drain to remove any fluid oozing from the wound. Sometimes a fine tube (catheter) is placed into the bladder to help you pass urine.
All of these tubes will gradually be removed as your condition improves.
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