Craniotomy
What is Craniotomy?
A craniotomy is the removal of a portion of the bone from the skull to uncover the brain for Surgery. The surgeon uses special instruments for cutting the bone segment (the bone flap). The bone flap is replaced after the brain surgery, and attached it with small titanium plates and screws to the surrounding bone.
How is craniotomy performed?
The neurosurgeon cuts out a bone area from your skull during a craniotomy. It gives them an opening so they can work on the brain. Before the procedure, you may have scans to let the surgeon know where the tumour is. You may also have scans during the procedure. Many of those scans are loaded into a computer to provide the tumour’s precise location. Your surgeon puts the bone back after removing the tumour. With small metal brackets, they secure the bone, and stitch the skin over it. In most cases, your hair will conceal the scar.
What are the types of Craniotomy?
Awake craniotomy
When the tumour is close to a part of the brain that regulates essential functions like voice, movement, or feeling, an awake craniotomy is performed.
There are various ways of having an awake craniotomy. Some people are awake (conscious) for portion of the operation while some may be up all the time.
If you are going to be awake for portion of the surgery, you have a general anaesthesia at the beginning. The anaesthetic is then reduced so that you wake up for the main part. You then have another general anaesthetic for the final part of your Surgery.
The surgeon asks you to do tasks during an awake craniotomy while they check the function of various parts of the brain. They might ask you, for example, to talk, move a part of your body or ask you what you can feel
Upon removal of the tumour, the surgeon repairs the skull and stitches the skin.
The thought of getting brain Surgery while you are awake can sound very frightening. In the procedure, you have an anaesthetic to relax any places that cause discomfort such as the skin and muscle. The brain itself has no Pain receptors so it feels no Pain.
Neuroendoscopy
Neuroendoscopy is also termed keyhole brain Surgery. You might have it to remove all or part of a tumour in the brain (ventricles). You may also be given a neuroendoscopy to eliminate fluid build-up in your brain (hydrocephalus).
An endoscope is a medical device consisting of a long tube with a camera connected to a monitor and an eyepiece. The surgeon makes a small hole in the skull. It is known as the Burr hole. Then the endoscope is placed into the hole. Through the eyepiece or on a monitor, the surgeon will see what is at the tip of the endoscope. On the end of the endoscope tiny forceps and scissors are present for removal of the tumour.
Removing a pituitary tumour via the nose
The pituitary is a tiny gland above the back of your nose. Your surgeon may be able to remove a tumour in the pituitary gland through the nose. This procedure is called transsphenoidal Surgery.
Your surgeon usually makes a small cut in the bone and cartilage on the thin wall, separating the nostrils (the nasal septum). They put tools through this hole up to the pituitary gland to remove the tumour.
What are the risks and side effects of craniotomy?
- Infection
- Bleeding
- Blood clots
- Pneumonia (infection of the lungs)
- Unstable blood pressure
- Seizures
- Muscle weakness
- Brain swelling
- Leakage of cerebrospinal fluid (the fluid that surrounds and cushions the brain)
