craniotomy

A craniotomy is a surgical procedure in which a section of the skull is temporarily removed to access the brain or surrounding structures. The bone flap is typically replaced at the end of the operation and secured with plates and screws. Craniotomy is distinguished from craniectomy, in which the bone is not immediately replaced.

Indications include removal of intracranial tumors, evacuation of hematomas (such as subdural or epidural collections), relief of mass effect after traumatic injury, treatment of aneurysms or arteriovenous malformations, and surgical biopsy or focal epilepsy surgery.

Procedure overview: under general anesthesia, imaging guides entry. After a scalp incision, burr holes are drilled and a bone flap is raised. The dura mater is opened to expose the brain, allowing the surgeon to perform the intended intervention. The brain tissue is carefully manipulated or resected as needed. The dura is closed, and the bone flap is replaced with fixation hardware. The incision is closed in layers. Neurophysiologic monitoring may be used.

Variants include mini- or keyhole craniotomies that use smaller bone openings for select targets.

Risks and complications include infection, bleeding, neurologic deficit, stroke, seizures, edema, CSF leak, and anesthesia-related complications. Outcomes depend on the underlying condition and the extent of surgery.

Recovery varies by procedure and patient; most patients stay in hospital for days to weeks with imaging to assess results, and rehabilitation may be required.

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