It is also important to ensure a good cosmetic result by keeping incisions behind the hairline and away from the face.
Craniotomy is any bony opening that is cut into the skull to access the brain underneath. There are many types of craniotomies, which are named according to the area of skull to be removed typically the bone flap is replaced. If the bone flap is not replaced, the process is called a craniotomy.
Craniotomies are also named according to their size and difficulty. Small dime-sized craniotomies are called burr holes or keyhole craniotomies. Sometimes stereotactic frames, image-guided computer systems, or endoscopes are used to precisely direct instruments through these little holes. Burr holes or keyhole craniotomies are used for minimally invasive procedures to:
- remove a small sample of abnormal tissue
- drain a blood clot
- insert an endoscope to remove small tumors and clip aneurysms
- insert a shunt into the ventricles to drain cerebrospinal fluid
- insert a deep brain stimulator to treat Parkinson Disease
- insert an intracranial pressure (ICP) monitor
Large or complex craniotomies are often called skull base surgery. These craniotomies engage the removal of a portion of the skull that supports the bottom of the brain where weak cranial nerves, arteries, and veins exit the skull. Reconstruction of the skull base is often necessary and may necessitate the additional expertise of head-and-neck, otologic, or plastic surgeons. Surgeons often use sophisticated computers to plan these craniotomies and locate the lesion. Skull base craniotomies can be used to:
- remove tumors that invade the bony skull
- remove or treat large brain tumors, aneurysms, or AVMs
- treat the brain following a skull fracture or injury