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A craniotomy is a type of surgery done to open part of the skull, or cranium. This procedure is needed when a person has a condition or injury that affects the brain, its tissues, or its blood vessels.

Who is a candidate for the procedure?

A craniotomy allows the surgeon to:

• remove a lesion, such as a brain tumor
• remove a blood clot, such as a chronic subdural hematoma
• repair a leaking blood vessel, known as a cerebral aneurysm
• remove an abnormal collection of blood vessels, known as arteriovenous malformation (AVM)
• drain a pocket of pus, also called a brain abscess
• repair skull fractures caused by a head injury
• repair a tear in the membrane lining the brain
• relieve increased intracranial pressure (excess pressure on the brain within the cranial cavity)

How is the procedure performed?

A craniotomy is performed under general anesthesia. This means the person is put to sleep with medication, feels no pain, and has no awareness of the procedure. The hair on all or part of the scalp is shaved. An incision is made in the scalp over the area of the suspected condition or disorder. A flap of the bone is cut away from the skull and set aside during the surgery. The disorder is located and treated. The bone flap is replaced, and the scalp is closed with sutures or clips.

What happens right after the procedure?

After the procedure, the person will be taken to the surgery recovery room or an intensive care unit. A endotracheal tube (breathing tube) may be left in place for a short time until the effects of the anesthesia have worn off. Since there is some risk involved with this surgery, a healthcare professional will check vital signs often by doing the following:

• checking the reaction of the person's pupils with a flashlight.
• asking the person simple questions to determine his or her mental status. For instance, the person may be asked his or her name, the date, and where he or she is.
• evaluating movement in the person's arms and legs.

A turban-like dressing or soft adhesive dressing will be placed over the incision. Pain medication will be given as needed.

What happens later at home?

Most people need to stay in the hospital from 5 to 14 days after a craniotomy. Their activity is slowly increased. It is common for people to feel tired for 6 weeks after surgery. Depending on the area of the brain affected, the person may need physical therapy, occupational therapy, or speech therapy to regain normal function.

If surgery was performed for a cancerous brain tumor, radiation therapy or chemotherapy may be needed.

What are the potential complications after the procedure?

• bleeding into the brain, which may require a second craniotomy
• infection
• reactions to anesthesia
• stroke
• seizures
• swelling of the brain, which may require a second craniotomy
• permanent brain damage with associated disabilities