Craniotomy

A craniotomy is a type of surgery that involves temporarily removing a small part of the skull, so surgeons have access to the brain. It’s often recommended when treating neurological conditions, such as tumors, infections, and acute injuries. A craniotomy is performed by neurosurgeons who use special tools to remove a section of the skull bone called the bone flap, which is replaced immediately after the surgery is finished. It’s often guided by magnetic resonance imaging (MRI) or computerized tomography (CT).

While a craniotomy is a serious procedure, most patients make a full recovery and do not experience complications. Penn Medicine’s neurology specialists can discuss the procedure with you and answer any questions you have so you feel comfortable with your treatment plan.

There are multiple types of craniotomy based on the location of the brain tissue that surgeons need to access. They include:  

• Frontal: At the front of the skull
• Temporal: Next to the eyes and in front of the ear
• Parietal: Near the top center and upper rear of the skull
• Pterional (frontotemporal): Behind the temple
• Orbitozygomatic: Near the eye socket and cheek
• Retrosigmoid (keyhole): Behind the ear
• Suboccipital: At the base of the skull, above the neck 

While eligibility for craniotomy surgery depends on each patient’s individual care needs and health factors, the most common reasons for the procedure include:  

• Brain tumor
• Cerebral aneurysm
• Traumatic brain injury (TBI)
• Brain abscess and infection
• Cerebral edema (swelling)
• Internal skull bleeding
• Blood clot
• Skull fracture
• Dura mater tear (tear in the outer layer of tissue that protects the brain and spinal cord)
• Arteriovenous malformation (improper formation of blood vessels)
• Arteriovenous fistula (abnormal connections between arteries and veins)
• Intracranial pressure
• Epilepsy and seizure disorder 

Your doctors will determine if a craniotomy is the best choice for treatment based on blood tests, a full physical examination, and recommended imaging tests. Your surgeon will then provide instructions on how to prepare for surgery, including instructions for fasting and if you need to stop taking medications prior to the procedure.

A craniotomy procedure generally lasts three to five hours but varies depending on the complexity of the procedure and other factors related to your care needs. You’ll first be given anesthesia to minimize pain and discomfort. Your surgical team will then remove the bone flap by making several small openings in the skull using a special drill.

After the bone flap has been removed, your surgical team will perform the procedure, replace the bone flap, realign whatever muscles or tissues needed to be adjusted, and close the incisions.

Some types of craniotomy surgeries require patients to be awake during the procedure so surgeons can measure brain function and response. This is particularly important for surgery on the part of the brain that controls mobility, motor skills, vision, and speech. Penn Medicine is a national leader in awake craniotomy with brain mapping, an innovative procedure that uses advanced technology to map the brain before and during surgery to pinpoint areas of the brain that control different behaviors. 

Full recovery from a craniotomy generally takes about two to three months, but the timeline can vary based on your specific care needs. Patients remain in the hospital for an average of five to seven days following the procedure. Your care team will provide instructions for post-operative care while your incisions heal and let you know how long it will take to resume normal activities. Each member of your care team will monitor your progress during recovery and advise you on when you can resume strenuous physical activity.

You may experience some short-term side effects during the recovery period, including headache, dizziness, and balance issues, though they will resolve over time. Contact your care provider if your incisions won’t close, you’re experiencing severe pain or swelling, or if you develop a fever. Your care team will be available throughout your recovery period to ensure that your healing progresses well. 

While a craniotomy is a safe and common procedure, some common risks may include:  

• Bleeding
• Pain and headaches
• Infection
• Hydrocephalus (buildup of fluid in the brain)
• Stroke
• Seizure
• Coma  

Your care team will thoroughly review the risks before making the recommendation to move ahead with surgery.

While you may be concerned about having a craniotomy, the Penn Medicine surgical team will be with you every step of the way to answer questions and put you at ease. Your procedure will be performed by experienced, nationally recognized neurosurgeons who perform thousands of craniotomies each year for advanced and complex brain conditions. You’ll receive an exceptional level of care before, during, and after surgery to speed your recovery.