Craniotomy and Craniectomy


Your doctor may recommend
a craniotomy or craniectomy procedure to treat a
number of different brain diseases, injuries,
or conditions. Your skull is made
of bone, and serves as a hard, protective
covering for your brain. Just inside your skull,
three layers of tissue called meninges
surround your brain. The thick, outermost
layer is the dura mater. The middle tissue layer
is the arachnoid mater, and the innermost
layer is the pia mater. Between the arachnoid
mater and the pia mater is the subarachnoid
space, which contains blood vessels and a clear fluid
called cerebrospinal fluid. Blood vessels, called
bridging veins, connect the surface of your
brain with the dura mater. Other blood vessels,
called cerebral arteries, bring blood to your brain. Inside your skull,
normal brain function requires a delicate
balance of pressure between the blood in
your blood vessels, the cerebrospinal fluid
that surrounds your brain, and your brain tissue. This is called normal
intracranial pressure. Increased intracranial
pressure may result from brain
tumors, head injuries, problems with your
blood vessels, or infections in your
brain or spinal cord. These conditions put
pressure on your brain, and may cause it
to swell or change shape inside your skull, which
can lead to serious brain injury. Your doctor may
recommend a craniotomy to remove abnormal brain
tissue such as a brain tumor, a sample of
tissue by biopsy, a blood clot called a hematoma,
excess cerebrospinal fluid, or pus from an infection
called an abscess. A craniotomy may also be done
to relieve brain swelling; stop bleeding,
called a hemorrhage; repair abnormal blood vessels;
repair skull fractures; or repair damaged meninges. Finally, a craniotomy
may also be done to treat brain
conditions such as epilepsy, deliver medication
to your brain, or implant a medical device
such as a deep brain stimulator. The most common reason
for a craniotomy is to remove a brain tumor. Before your procedure, you will
be given general anesthesia to make you unconscious
and pain-free. The skin on your
scalp will be shaved over the location of the tumor. To begin, your surgeon will
make an incision in your scalp. One or more small holes
will be made in your skull. Then, your surgeon
will connect the holes to create a circular piece
of bone called a bone flap, and remove it. Your surgeon will make an
incision in the dura mater to expose your brain. Then your tumor will be removed. The incision in the dura mater
will be closed with sutures. Your surgeon will reattach the
bone flap with metal plates and screws that will remain
in your skull for life. You may have a variation
on a craniotomy called a craniectomy, if your
brain is very swollen or your skull is infected. Your surgeon may delay
reattaching the bone flap until a later procedure, to
allow time for the swelling to go down. At the end of either a
craniotomy or a craniectomy, your scalp incision will
be closed with staples, and your head will be
wrapped in bandages. If you had a craniectomy, you
will have another procedure called a cranioplasty
at a later date, after the swelling goes down. At that time, your surgeon
will reattach your bone flap with metal plates
and screws, then close the skin
incision with staples. After either procedure,
you will stay in the hospital
for several days. Your caregiver will
check your brain function by asking you questions, and
shining a light in your eyes. You may be given medication
to prevent complications.