CRANIECTOMY

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What is craniotomy?

During a craniotomy, a small piece of skull is removed so that a surgeon can access the brain. Once the tumor has been removed, the bone fragment is put back in place. Sometimes, the bone fragment is secured with small plates or screws, and heals like a bone fracture.

Craniectomy

A craniectomy is a surgical procedure that is very similar to a craniotomy, but with one key difference. After a craniectomy, the bone fragment is not immediately put back into place. This approach may be taken if there is significant swelling in the brain and a surgeon deems it necessary to relieve pressure within the skull. The bone fragment is typically kept so that it can be put back into place during a future surgery, although it may also be discarded in favor of a future reconstruction using an artificial bone.

Why Craniectomy is done?

Craniectomy is typically performed as a life saving measure. Patients who have experienced a severe brain injury that is life threatening may have bleeding around their brain or swelling of their brain so severe that it can lead to brain compression and brain death. In this type of dire situation, neurosurgeons can remove a portion of the skull, evacuate any underlying clot that is compressing the brain, and relieve pressure on the brain. Furthermore, because the brain typically experiences a great deal of swelling after a severe injury, removing the bone frees the brain to swell upward rather than downward where it will compress the brainstem, which is critical for all of the basic vital functions, leading to brain death. Over time the brain swelling will subside and the bone that was removed can be replaced.

A craniotomy may be done for a variety of reasons, including, but not limited to, the following:

    • Diagnosing, removing, or treating brain tumors.
    • Clipping or repairing of an aneurysm.
    • Removing blood or blood clots from a leaking blood vessel.
    • Removing an arteriovenous malformation (AVM) or addressing an arteriovenous fistula (AVF).
    • Draining a brain abscess, which is an infected pus-filled pocket.
    • Repairing skull fractures.
    • Repairing a tear in the membrane lining the brain (dura mater)
    • Relieving pressure within the brain (intracranial pressure) by removing damaged or swollen areas of the brain that may be caused by traumatic injury or stroke.
    • Treating epilepsy.
    • Implanting stimulator devices to treat movement disorders such as Parkinson’s disease or dystonia (a type of movement disorder).

There may be other reasons for your doctor to recommend a craniotomy.

The risks of Craniectomy

The major risks of the operation are bleeding and infection and further damage to the brain. As previously stated, patients who require craniectomy as a life saving measure are usually in very critical condition and have in all likelihood already experienced some amount of brain damage. Nevertheless, the surgical team makes every effort to limit the risks of the operation to the patient by administering antibiotics before beginning, controlling all bleed encountered during the surgery, and limiting the amount of manipulation of the brain.

The following complications are rare and generally relate to specific locations within the brain, so they may or may not be valid risks for certain individuals:

    • Memory problems
    • Speech difficulty
    • Paralysis
    • Abnormal balance or coordination
    • Coma

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

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