A craniotomy is a procedure that (temporarily) removes some of the bones in the skull to gain access to the brain. The procedure is performed in the case of many different diseases - thanks to it, it is possible to both treat brain aneurysms and resect tumors of the central nervous system.

Craniotomyis a procedure based on the excision of a fragment of the skull bone, thanks to which access to the brain tissues is obtained. Most likely, craniotomy was performed in very distant times. Such a conclusion allowed to put forward bone remains found in the 17th century in France, the origin of which dates back to 8,000 BC. These remains bore traces suggesting that craniotomy-like surgeries had already been carried out in such a distant past. Nowadays, this procedure - of course with many modifications - is still performed, moreover - the number of indications for its performance is relatively large. Craniotomy should be clearly distinguished from a procedure with a similar sounding name, i.e. from a craniectomy. During the first one, the cut bone fragment is later put back in place, while during a craniectomy the given bone part undergoing this procedure is permanently removed.

Craniotomy: course of the procedure

Patients usually undergo general anesthesia while performing craniotomy. Before craniotomy, it is necessary to shave the area of ​​the scalp where the opening of the cranial cavity will be performed. The procedure can be performed in various places of the skull - a fragment of the frontal, parietal or temporal bone, as well as fragments of several different bones of the skull, can be temporarily resected. Before that happens, however, there is a need to expose the surface of the skull. To do this, an incision is made within the skin (e.g. around the ear) and then the skin flap (called a scalp) is separated from the bone. At this point, it is possible to proceed to the main part of the procedure, i.e. opening the cranial cavity. The initial stage is drilling a few small holes within the bone. Then, between the holes made, the surgeon gently saws the bone. After performing all these activities, the bone plate is separated and properly secured. Then there is a need to separate the tirehard against the surface of the brain, the dura mater is also cut, and the craniotomy is done to access brain tissue. Other activities performed by surgeons depend on the indications for craniotomy. The final stage of craniotomy procedures is restoring the previously cut bone fragment. It is connected with the remaining bones of the skull with the help of stitches or special plates. After performing these activities, the skin flap, deviated at the very beginning of the procedure, is sewn back into place.

It is difficult to say exactly how long a craniotomy takes - it is usually one of the elements of a more complicated procedure. It is generally accepted that craniotomy operations typically take about four to six hours.

Craniotomy can be performed with the support of diagnostic imaging equipment (in this case, mainly magnetic resonance imaging is used) and specialized computer analyzers. Such devices are used to be able to precisely define the place where the surface of the brain will be exposed. This type of craniotomy is known as a stereotaxic craniotomy.

Craniotomy: indications

Gaining access to the brain through craniotomy can be helpful for many different brain diseases, such as:

  • tumors of the central nervous system (in this case, craniotomy can be used both to treat these diseases and to collect biopsy materials for the diagnosis of brain proliferative diseases)
  • brain abscesses
  • aneurysms of the cerebral vessels
  • malformations of cerebral vessels
  • intracranial hematomas
  • increased intracranial pressure

Other indications for craniotomy are:

  • removal of foci responsible for the occurrence of epileptic seizures
  • the need to gain access to brain structures to implant devices such as a stimulator of the brain's electrical activity or the peritoneal valve

Craniotomy: contraindications

There are probably no typical contraindications for craniotomy - contraindications may relate to a specific type of surgery that is to be accompanied by craniotomy. However, there are certain factors that may increase the risk of a craniotomy. As such, it is mentioned:

  • old age of the patient
  • general ill he alth of the patient
  • cardiovascular and respiratory diseases (especially their unregulated formsmileage)

Craniotomy: recovery after surgery

Patients are closely monitored after the craniotomy. The time of hospitalization required after the procedure is variable, depending mainly on the patient's main illness and general condition. For one patient, a stay in the hospital for 3 days after a craniotomy will be sufficient, for another, hospitalization will have to last 2 weeks. Upon discharge from the hospital, the patient receives a number of recommendations. For the first few days after the craniotomy, he should:

  • avoid strenuous efforts - after the treatment you should mainly rest
  • do not drive a car until the doctor has given permission to do so
  • refrain from washing the operated area for about 3-4 days (unless your doctor tells you otherwise)
  • refrain from consuming alcohol

Patients can leave the hospital with the recommendation to take various medications. Painkillers and antiepileptic drugs are recommended preparations - the latter are supposed to reduce the risk of seizures that may occur after a craniotomy. Patients are also allergic to certain symptoms, the occurrence of which would suggest the need to see a doctor urgently. These include fever, the appearance of pus in the postoperative wound, dizziness, as well as significant disturbances in muscle strength, severe headaches and severe vomiting. The first follow-up visit after craniotomy usually takes place 7-14 days after the surgery - this is when The stitches usually placed at the end of the operation are removed. Removal of stitches does not end the recovery period - its total duration is on average 4 to 8 weeks. During it, patients should gradually increase the level of their activity, as well as attend rehabilitation.

Craniotomy: possible complications

Each surgical procedure carries the risk of certain complications - the same is true for craniotomy. Examples of complications after craniotomy include:

  • intracranial hematoma
  • intracranial pneumothorax
  • brain swelling
  • surgical site infection
  • stroke (occurs when some blood vessels in the brain are damaged during the procedure)
  • cerebrospinal fluid leak to the outside of the skull
  • difficulties with opening the mouth and chewing food (occurring in the event of damage to the muscles responsible for the function of the mandible, this complication is usually temporary)

Category:

Neurology