General information: A craniotomy or craniectomy is the most common surgical procedure used to access intracranial compartments and treat different types of condition that need surgical treatments like head injuries, brain tumours, bleeding, infection etc.
Craniotomy, is a temporary removal of part of the skull bone to access the intracranial compartment depending on the type and the site of the access needed. Surgeon is usually used powered instruments to facilitate the process.
The procedure is usually done under general anesthesia, with local anesthetic infiltration of the tissue to decrease the pain and discomfort after the surgery.
Once the target of the surgery acheived, The dura and meninges will be repaired, the bone will be replaced and fixed with a mini plates and the skin will be repaired in layers.
In certain cases when there is a severe swelling of the brain like after head injury, stroke, brain bleeding etc, the surgeon may decide to re-insert the bone flab to give more space for the brain to expand. the procedure is called Craniectomy. Patient will need another surgery to replace the bone flab later when the brain swelling improve, the procedure is called cranioplasty.
In other cases, an access to the posterior part of the brain(hindbrain) which involves the cerebellum and the posterior cranial fossa contents, the surgical approach is called suboccipital craniotomy or craniectomy. It has similar principlesof craniotomy except the position of the patient would be prone or lateral position. If the surgeon decided to do craniectomy, it would be very unlikely to do cranioplasty at later stages as the area is covered and protected by good layers of neck muscles.
Risk of complications:
- Infection is less than 2 percent. It may affect the superficial tissues and skin, or may affect deep structures like skull bone(osteomyelitis), meninges(meningitis) or brain tissue(cerebritis or brain abscess). It also may lead to pus collection under the meninges(subdural abscess) or outside the meiniges (epidural abscess). These complications are very rare, <1%.
- Bleeding which may lead to hematoma collection and pressure at the brain that may need further surgery.
- Cerebrospinal fluid (CSF) leak through the skin with small risk of meningitis.
- Neural tissue injury: the most serious complication may cause life changing consequences in form of weakness or paralysis of legs, sphincters, sensory or sexual changes. The risk is very variable according to the area of the brain targeted and the underlying cause that needed surgery.
- Injury to the blood vessels of the brain leads to stroke with a variable neurological deficit depending on the area of the brain affected.
- Seizure , either immediately or shortly after surgery.
- Failure to improve symptoms.
- General anesthetic complications (heart attack, stroke)
- Deep venous thrombosis/pulmonary embolism (clots in legs / lungs).
- Small risk to life.