Craniotomy and Craniectomy

What Is a Craniotomy?

A craniotomy is a surgical procedure where a neurosurgeon removes a section of the skull, known as a bone flap, to access the brain. After addressing the underlying issue (such as removing a tumor or repairing a blood vessel) the bone flap is typically replaced and secured with plates or screws. Craniotomies are commonly used to treat brain tumors, aneurysms, arteriovenous malformations, and to relieve pressure from brain swelling.

What Is a Craniectomy?

A craniectomy is similar to a craniotomy in that it involves removing a portion of the skull. However, in a craniectomy, the bone flap is not immediately replaced. This approach is often used when the brain is swollen, as leaving the bone flap off allows the brain to expand without being compressed. Once the swelling subsides, a separate procedure called a cranioplasty may be performed to restore the skull's integrity.

Both craniotomy and craniectomy are performed to address serious brain conditions, including:

• Brain tumors
• Aneurysms
• Arteriovenous malformations
• Traumatic brain injuries
• Intracranial hemorrhages
• Brain abscesses
• Epilepsy surgery

The choice between a craniotomy and a craniectomy depends on the specific medical situation and the patient's condition.

Before Surgery:

• Comprehensive neurological examination and imaging studies (MRI or CT scans)
• Discussion of the surgical plan, risks, and benefits with the neurosurgical team
• Preoperative assessments to ensure fitness for surgery

During Surgery:

• Administration of general anesthesia
• Removal of the bone flap to access the brain
• Treatment of the underlying condition
• In a craniotomy, the bone flap is replaced; in a craniectomy, it is left off temporarily

After Surgery:

• Monitoring in the neuro intensive care unit (ICU)
• Pain management and prevention of complications
• Gradual recovery with possible rehabilitation services

Recovery times can vary, with some patients resuming normal activities within weeks, while others may require longer periods, especially if additional procedures like cranioplasty are needed.

As with any major surgery, these procedures carry potential risks, including:

• Infection
• Bleeding
• Brain swelling
• Seizures
• Neurological deficits
• Reactions to anesthesia

Your neurosurgical team will take precautions to minimize these risks and will discuss them with you before the procedure.