Revealing the secrets of craniotomy, is it really as scary as imagined?

Author: Pan Pengwei, The First Affiliated Hospital of Zhengzhou University

Reviewer: Zhang Qi, deputy chief physician, First Affiliated Hospital of Zhengzhou University

Craniotomy is a major brain surgery in which surgeons remove part of the patient's skull to access the patient's brain and perform other surgical operations. Although this process sounds scary, it is very common in clinical work, especially for critically ill patients. Therefore, having a certain understanding of this operation can help patients better understand their disease and facilitate recovery.

In the narrow space between the brain and the skull, any swelling or extra fluid (such as bleeding in the brain) can put tremendous pressure on the skull, which can cause serious brain damage and be life-threatening. Because brain function is extremely sensitive to pressure, any form of severe compression must be relieved as quickly as possible. To deal with this, the medical team may consider performing a craniotomy to reduce swelling, relieve pressure, or remove excess fluid from the brain. Surgeons often call this type of surgery a decompressive craniotomy, and it aims to quickly relieve the high pressure within the skull and protect the patient's brain function.

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1. What diseases can be treated by craniotomy?

Craniotomy is a treatment for a variety of brain diseases. It is mainly used to solve problems such as brain swelling, increased intracranial pressure, cerebral hemorrhage or cerebral fluid accumulation caused by craniocerebral trauma, stroke, thrombosis and cerebral hematoma. It aims to alleviate symptoms and promote patient recovery.

2. How should patients prepare for craniotomy?

Craniotomy is often an emergency surgery. Patients may not have time to prepare for this surgery.

Before surgery, surgeons and nursing teams need to complete physical examinations, routine blood tests, imaging studies [X-rays, magnetic resonance imaging (MRI), CT scans, PET scans, or angiography], etc. After a thorough examination and evaluation, surgeons will recommend whether craniotomy is needed.

If your surgery is not an emergency, your surgeon will tell you if you need to stop taking any medications before surgery, especially anticoagulants. Your surgeon may recommend taking antibiotics or anti-seizure medicines beforehand. You will need to fast for a period of time before surgery and should not eat anything.

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3. What is the patient’s state of consciousness during craniotomy?

Before surgery, an anesthesiologist will give the patient anesthesia so that the patient will not feel pain. For some types of craniotomy, the patient will be asleep and have no memory of the procedure. Sometimes, the patient will be asked to be awake so that the surgeon can monitor the patient's cognitive function and facilitate the operation.

4. How long does a craniotomy take?

A craniotomy usually takes 3 to 5 hours to complete. Some surgeries take longer, depending on why the patient needs a craniotomy.

5. What should I pay attention to after craniotomy?

After craniotomy, you will likely be transferred to an intensive care unit. The medical team will monitor your vital signs and any bleeding or swelling in your brain. Since the portion of your skull that was removed during surgery will not be put back in place, you will not have the skull to protect your brain, so you will need to be careful to protect your brain from damage after surgery.

Surgeons will save the pieces of your skull that were removed so they can be reused in a future procedure (called cranioplasty). It may also be possible to replace your skull fragments with metal plates or synthetic materials in the future.

6. What is the success rate of craniotomy?

There are many variables that go into calculating the success rate of surgery, including the patient's overall health and the reason for the surgery. Long-term neurological care and rehabilitation improve the success rate. Some people may not fully recover, especially if the reason they had surgery was a stroke. Many people recover from open craniotomy, but they may have adverse effects.

7. What are the risks or complications of craniotomy?

Risks associated with craniotomy include: bleeding, brain herniation, persistent increased intracranial pressure, brain damage, infection, seizures, paralysis, mental or behavioral abnormalities, coma, etc. These complications can be fatal. Patients may be at increased risk of falling and lose balance and coordination after surgery, so it is important to rest until patients are healthy enough to walk or move on their own. The surgeon will tell patients what to expect during the postoperative recovery period and when patients can start to move again after craniotomy.

8. How long does it take to recover from craniotomy?

Recovery time after craniotomy will depend on the reason and extent of the surgery. On average, your skull will heal in 1-2 months, but it may take years for your brain to function again. When you have a second surgery (cranioplasty) to replace the portion of your skull that was removed, your recovery will take even longer. Extended recovery time and lifelong care after craniotomy are common.

9. What is the prognosis of craniotomy?

Many people survive craniotomy and make a full recovery. Some may need to continue taking medications and have side effects. Your survival rate will depend on your reason for the surgery and your overall health.

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10. When is a follow-up visit required after surgery?

Patients returning home after surgery should consult their surgeon if they have a fever, severe pain and swelling, changes in cognitive function, mood or behavior, or severe headaches. If the patient has a seizure, difficulty breathing, or signs of a stroke, please call 120 for emergency medical treatment. The earlier you see a doctor, the better the recovery and improvement of your symptoms.

Craniotomy is an important life-saving surgery. It can reduce complications caused by bleeding (excess fluid) or swelling that puts pressure on the brain. You may need this type of surgery after a traumatic brain injury or stroke. Many people recover fully after surgery, but there may be sequelae. While your incision site may heal within a few weeks, you may need months to years of rehabilitation and lifelong follow-up care after craniotomy.