Cranial Surgery

Cranial Surgery

A craniotomy clearly means creating an opening into the skull to represent the brain. The standard way to perform this surgery is to make a burr hole with a drill and then cut the bone flap through the bone with a special saw. Generally, more than one burr hole is used.

The patient’s head is held in a three-pin cranial fixation clamp to stop head movement during weak parts of the operation. This is known as minimally invasive or keyhole surgery.

About Cranial Surgery

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

What are the risks?

What are the risks?

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:

  • nerve damage, which may reason muscle paralysis or weakness
  • CSF leak, which may require repair
  • loss of mental functions
  • permanent brain damage with associated disabilities
  • stroke
  • seizures
  • swelling of the brain, which may require a second craniotomy