The surgical operations in which a bone flap is temporarily removed from the skull to access the brain in patients with a brain lesion due to a brain tumor, blood clots developing for various reasons, removal of certain foreign bodies or traumatic brain injury are called “craniotomy”. It is important that craniotomy operations are performed by experienced neurosurgery teams.

What is a craniotomy?

Reaching structures within the skull is the surgical removal of part of the bone from the skull to expose the brain.

In which cases is craniotomy applied?

The situation in which the skull bone is removed in order to reach all the problems that require surgery in the head is called craniotomy.

Craniotomy is applied in every situation where it is desired to reach every pathology in the brain. In a certain location of the skull, in the neighborhood of the problem, the skull is opened and the bone is removed.

In general, to reach the brain tissue, structures in the cerebral cortex, neurovascular structures, that is, brain tumors, neurovascular lesions, lesions such as aneurysms and AVMs; Craniotomy is applied in brain hemorrhages, head traumas, swollen brains, in order to open the skull and relieve the brain outward.

Craniotomy can be performed for the following reasons;

  • Diagnosing, removing and treating brain tumors
  • Circulating an aneurysm
  • Removing blood or blood clots from a leaky blood vessel
  • Removing an arteriovenous malformation (AVM) or treating an arteriovenous fistula (AVF)
  • Draining an infected pus-filled brain abscess
  • Repairing skull fractures
  • Repairing tears in the membrane covering the brain (dura mater)
  • Relieving pressure inside the brain (intracranial pressure) by removing damaged or swollen areas of the brain that could result from a traumatic injury or stroke
  • epilepsy treatment

How is craniotomy surgery done?

Craniotomy can be performed with the patient asleep or awake, depending on the patient’s condition.

The patient is usually put on a spiked cap under general anaesthesia. The bone immediately adjacent to the lesion is drawn using conventional methods or a method called neuronavigation. After the skin is opened, the bone is opened with a pneumatic drill device. After the bone opening process, the dura, which is the thickest and outermost layer of the cerebral membranes surrounding the brain tissue and spinal cord, is reached. After the dura is opened, the brain layer is reached.

Frequently asked questions about craniotomy 

What are the advantages of craniotomy?

Thanks to the craniotomy, it is provided to reach the brain tissue quickly. In the past, craniotomy procedures took much longer because there were no technological instruments (pneumatic drill, neuronavigation). Now, thanks to these devices, craniotomy can be performed in about half an hour.

Is craniotomy a risky surgery?

Craniotomy is a brain surgery that involves temporarily removing bone from the skull to repair the brain. Therefore, it brings some risks. Just under the skull, there are some vascular structures, venous sinuses carrying dirty blood, and brain tissue. In the craniotomy procedure, the cerebral cortex may rupture and damage the brain tissue, or the venous sinuses carrying this dirty blood may also rupture. These situations can cause problems that are reflected during or after some surgery.

However, risks are minimized when performed under appropriate conditions and by expert teams.

What are the points that the patient should pay attention to before craniotomy?

It is sufficient for the patient to have a general anesthesia examination before the operation.

How long does craniotomy surgery take?

Craniotomy surgery varies according to the patient’s condition and general picture. The skull bone is removed according to the area to be treated. However, this is only the duration of the craniotomy surgery. After the bone is removed, the surgery to be performed inside the brain is performed at varying times depending on the pathology and location of the problem.

How is brain mapping performed in craniotomy surgery?

Before the craniotomy surgery, some radiological imaging is applied. MR (functional MR, MR tactography), neuronavigation and anatomical landmarks determine the pathological structure and functional brain areas in the brain tissue.

Scans of the brain (neuronavigation and ultrasound) with these imaging devices provide a three-dimensional image of the brain, for example, if there is a tumor. It is useful in distinguishing between tumor tissue and healthy tissue and in reaching the precise location of abnormal tissue.

When to apply for an awake craniotomy?

In general, craniotomy surgery is performed while the patient is under general anesthesia. However, craniotomy can be performed while awake in order to immediately intervene in the neurological deficits (risk of disability) that may occur during the operation and to stay away from those areas.

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