Complex Cranial surgery – craniotomy

Like any other organ in the body the brain can be threatened by a number or disease processes. This includes bleeding, infection, trauma, tumours and abnormalities that you are born with. Sometimes the treatment of these conditions requires brain surgery.

Cranial surgery is surgery performed on the skull, the cranium. The most common operation performed is called a craniotomy and this is conducted by a neurosurgeon. A craniotomy is an operation to open the skull (cranium0 to create a window to access the brain for surgical repair. 

The harder the part of the brain is to access, in terms of delicate surrounding structures, and depth into the brain, the more complex the surgery is. There are many different types of brain surgeries, but a craniotomy is usually a component of that is common to all of them. 

Craniotomy is surgery to cut a bony opening in the skull. A section of skull, called a bone flap, is removed to access the brain underneath. The size of the craniotomy is either small or large depending on the reason for the operation and the location in the brain that has to be accessed. In general, a smaller craniotomy is possible for abnormalities that are deep in the brain. 

This operation may be performed to treat brain growths, brain cancers, infections, abscesses, swelling of the brain (cerebral oedema), haematomas (blood clots), blood vessel abnormalities such as aneurysms, AVMs and cavernomas, traumatic head injury including removal of foreign objects due to penetrating injuries. 

At the end of the operation, the bone flap is almost always replaced. This is done with tiny plates and screws that are made of titanium. When your wound heals you may sometimes be able to feel these under your skin as tiny lumps. They should never be visible jutting through your skin. People are often concerned about triggering the security screening at the airport after a craniotomy. Because the plates and screws are small and made from titanium, to date they are not detected by airport security. 

Craniotomies are always tailor made for each individual patient. This is determined by your neurosurgeon and depends on a number of factors such as size and depth of the problem being treated. It can also depend on whether you have had previous brain surgery. 

In a small group of patients’ craniotomies are done with patients awake. The skin over your head, the skull and the membrane around the brain has sensation, but the brain itself has no sensation. This means that you will not feel anything when your brain is being operated on. 

This allows surgeons to perform some surgeries on the brain with their patients awake and able to help them with the operation. The patient is tested during the operation and any risk to injuring sensitive parts of the brain can be minimized by detecting this early before irreversible damage has been done. 

Recovery will depend on a number of factors including: 

  • The kind and severity of brain injury/ condition
  • The complexity of the operation performed
  • The duration of your surgery
  • The type of anaesthetic you required
  • Any complications that occurring during or immediately after surgery
  • Age and general health
  • Previous treatments such as prior surgery or previous radiation. 

After a craniotomy you will not be able to fly in a commercial aircraft for a period of at least two weeks to allow air trapped inside the skull to absorb. Your surgeon will provide you with specific recommendations for your condition. 

In South Australia the general recommendation after a craniotomy is that you do not drive for six months after your surgery. However, as craniotomies are done for various different conditions this may not be applicable to your case. Your surgeon will advise you on restrictions on driving after surgery. 

In order to perform a craniotomy some of your hair may have to be removed. The amount of hair removal will depend on the type of surgery you need and your surgeon. In some cases it is possible to do a craniotomy and remove almost no hair, making for a more satisfactory cosmetic result.