Craniotomy

Pronounced: Crane-knee-ah-toe-me
by Patricia Griffin Kellicker, BSN

Definition

A craniotomy is a surgery done on the head. The surgeon cuts through the skull to reach the brain. There are different types of craniotomies, including:

  • Burr hole—A small hole is made in the skull
  • Traditional craniotomy—A piece of skull is cut out and then put back after surgery
  • Stereotaxy—A computer is used to help find where things are in the brain during surgery
  • Awake craniotomy—The patient is awake during part of the surgery

Craniotomy

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Reasons for Procedure

The success of this surgery depends on the reason it is being done. The most common reasons for a craniotomy include:

  • Biopsy —to obtain a brain tissue sample
  • Brain cancer
  • Head trauma
  • Blood clot in the brain
  • Blood vessel problems with the brain
  • Nerve disorders
  • Brain swelling
  • Brain infection

Smoking may increase the risk of complications.

Possible Complications    TOP

If you are planning to have a craniotomy, your doctor will review a list of possible complications which may include:

  • Bleeding
  • Infection
  • Brain swelling
  • Damage to your brain which may cause:
    • Changes in memory, behavior, thinking, or speech
    • Vision problems
    • Problems with balance
    • Bowel and bladder problems
    • Seizures
    • Paralysis or weakness
  • Reaction to anesthesia, including light-headedness, low blood pressure, and wheezing
  • Heart attack
  • Blood clots

What to Expect    TOP

Prior to Procedure

If your surgery is planned, your doctor will review what will happen and what to expect afterwards. At your appointment before your surgery, your doctor may:

  • Perform an exam to check how your nerves and brain work
  • Order an MRI scan, CT scan, or PET scan of the brain
  • Ask questions like:
    • What kind of help will you have at home?
    • Do you have any new symptoms?

Be sure to ask your doctor any questions that you have, such as:

  • What will my recovery be like?
  • Will I need rehabilitation after surgery?
  • When will I be able to return to work?

Other things to remember:

  • Talk to your doctor about your medicines. Your doctor may ask you to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs
    • Blood thinners
  • Arrange for a ride home from the hospital.
  • Arrange for help at home while you recover.
  • You will be asked to fast for 8-12 hours before your surgery. Because of this, ask your doctor if you should take your regular medicines with a sip of water before your surgery.

Anesthesia

General anesthesia is used for most craniotomies. General anesthesia will block any pain and keep you asleep during the surgery. It is given through an IV in your hand or arm.

If you have an awake craniotomy, you will be given general anesthesia. You will be awake for part of the surgery.

If you have stereotaxy surgery, you may be given local anesthesia. This blocks just the area where surgery will happen.

Description of Procedure

After you are asleep and can no longer feel pain, a breathing tube will be placed. Your head will be shaved and your skin will be washed with an antiseptic. The surgeon will cut into part of your scalp. Next, part of your skull will be removed and your brain covering will be opened. Depending on the reason for your surgery, several things may happen: a tumor may be removed, a part of your brain tissue may be taken, a tube may be placed, or repairs to your brain or its vessels may be done. The brain opening will then be sewn back into place and your skull replaced. Staples or stitches will be used to close the incision. A drain may be inserted to remove blood and fluid for the first few days after surgery. A dressing will be wrapped around your head.

Immediately After Procedure

After your surgery, you will be taken to the recovery room to be monitored. Your mental status and vital signs will be checked often. After the recovery room, you may spend some time in the intensive care unit (ICU) or a step-down unit before being moved to a hospital room. This will depend on the reason for your surgery.

How Long Will It Take?

Several hours, depending on the type and reason for surgery

How Much Will It Hurt?

During surgery, you will feel no pain. After surgery, you will be given medicine to manage any pain.

Average Hospital Stay

3-7 days (Your doctor may keep you longer if complications occur.)

Post-procedure Care

At the Hospital

  • To reduce the risk of brain pressure build-up:
    • You may receive steroids and other medicines to keep your body fluid level low.
    • The head of your bed will be raised.
    • Fluids given to you may be limited.
    • You may be given medicines to prevent vomiting.
    • Do not strain or hold your breath unless your healthcare staff says it is okay.
  • Your mental status will be checked often.
  • You may receive medicine to prevent seizures.
  • You may receive antibiotics to prevent infection.
  • Your dressing will be removed 24-48 hours after surgery and replaced with lighter dressing.
  • You may have a drain inserted after surgery. In most cases, it will be removed in the hospital.
  • You may be asked to get out of bed and walk around to prevent complications like blood clots or pneumonia.

At Home

When you return home, do the following to help ensure a smooth recovery:

  • Get some help from family and/or friends as you recover.
  • Keep your incision clean and dry. Check it for redness, swelling, drainage, or separation of the edges.
  • Do physical therapy, occupational therapy, and/or speech therapy if ordered by your doctor. Therapists may come to your home or you may see them in their office.
  • Get enough rest and eat a healthy diet to help your body recover.
  • If you feel depressed, talk to a therapist, psychologist, or other counselor.
  • Be sure to follow your doctor's instructions.

Call Your Doctor    TOP

After you leave the hospital, contact your doctor if any of the following occurs:

  • Any changes in physical ability, including balance, strength, or movement
  • Any changes in mental status, including level of alertness, memory, thinking, or ability to respond
  • Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision
  • Headache that does not go away
  • Stiff neck
  • Changes in vision, including double, blurred, or vision loss
  • Fainting or seizures
  • Numbness, tingling, or weakness in your face, arms, or legs
  • Signs of infection, including fever and chills
  • Nausea and/or vomiting that you can't control with the medicines you were given after surgery or which continue for more than two days after leaving the hospital
  • Pain that you can't control with the medicines you've been given
  • Difficulty breathing
  • Cough, shortness of breath, or chest pain
  • Trouble controlling your bladder and/or bowels
  • Swelling, tenderness, hotness, or redness anywhere in your legs

In case of an emergency, call for medical help right away.

RESOURCES:

American Brain Tumor Association
http://www.abta.org/
National Brain Tumor Society
http://www.braintumor.org/

CANADIAN RESOURCES:

Brain Tumor Foundation of Canada
http://www.braintumour.ca
Canadian Cancer Society
http://www.cancer.ca/

References:

The essential guide to brain tumors. National Brain Tumor Society website. Available at: http://www.braintu... . Accessed February 6, 2013.
Guide to the care of the patient with craniotomy post-brain tumor resection. American Association of Neurological Nurses website. Available at: https://www.aann.org/pdf/cpg/aanncraniotomy.pdf . Accessed February 6, 2013.
Professional Guide to Diseases . 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.
White-Guthro M. Craniotomy. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/dynamed/ . Updated February 24, 2012. Accessed February 6, 2013.
6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed September 2012 by Marcin Chwistek, MD
Last Updated: 2/6/2013