what is the difference between a craniotomy and a craniectomy

what is the difference between a craniotomy and a craniectomy

CraniotomyOpen print version


Craniotomy is a surgical procedure to chop a bony opening within the cranium. A piece of the cranium, referred to as a bone flap, is eliminated to entry the mind beneath. A craniotomy could also be small or massive relying on the issue. It might be carried out to deal with mind tumors, hematomas (blood clots), aneurysms or AVMs, traumatic head damage, overseas objects (bullets), swelling of the mind, or an infection. The bone flap is often changed on the finish of the process with tiny plates and screws.

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What’s a craniotomy?

Craniotomies are named based on the world of cranium (skull) to be eliminated (Fig. 1). After the surgeon repairs the issue, the bone flap is then changed or coated with plates and screws. If the bone flap will not be changed, the process is named a craniectomy.

Determine 1. Craniotomies are sometimes named for the bone being eliminated. Some widespread craniotomies embody frontotemporal, parietal, temporal, and suboccipital.

Craniotomies differ in dimension and complexity. Small dime-sized craniotomies are referred to as burr holes; “keyhole” craniotomies are quarter-sized or bigger. Stereotactic frames, image-guided laptop programs, or endoscopes could also be used to exactly place devices by these small holes. Burr holes and keyholes are used for minimally invasive procedures to:

  • insert a shunt into the ventricle to empty cerebrospinal fluid (to deal with hydrocephalus)
  • insert a deep mind stimulator (DBS)
  • insert an intracranial strain (ICP) monitor
  • take away a pattern of tissue cells (needle biopsy)
  • drain a blood clot (hematoma aspiration)
  • insert an endoscope to take away tumors

Complicated cranium base craniotomies contain the removing of bone that helps the underside of the mind the place delicate cranial nerves, arteries, and veins exit the cranium. Reconstruction of the cranium base could require the extra experience of head-and-neck, otologic, or plastic surgeons. Surgeons usually use image-guidance programs to plan the entry for difficult-to-reach lesions to:

  • take away deep mind tumors or AVMs; clip aneurysms
  • take away tumors that invade the bony cranium

Whereas most cranium openings are made as small as potential, massive decompressive craniectomies are made to permit the mind to swell after a head trauma or stroke. The bone flap is frozen and changed months later after restoration (cranioplasty).

Awake craniotomies are carried out when a lesion is near essential speech areas. The affected person is asleep for the bone opening after which woke up to assist the surgeon map areas in danger. A probe is positioned on the mind floor when you learn or speak. Referred to as mind mapping, this course of identifies your distinctive mind areas for speech and helps the surgeon keep away from and shield these capabilities.

There are lots of sorts of craniotomies. Ask your neurosurgeon to explain the place the pores and skin incision will likely be made and the quantity of bone removing.

Who performs the process?

A craniotomy is carried out by a neurosurgeon; some have extra coaching in cranium base surgical procedure. A neurosurgeon may match with a workforce of head-and-neck, otologic, oculoplastic and reconstructive surgeons. Ask your neurosurgeon about their coaching, particularly in case your case is complicated.

What occurs earlier than surgical procedure?

The surgeon will clarify the process, its dangers and advantages, and you should have time to ask questions. Consent types are signed and paperwork accomplished to tell the surgeon about your medical historical past (e.g., allergic reactions, medicines, anesthesia reactions, earlier surgical procedures). Presurgical exams (e.g., blood take a look at, electrocardiogram, chest X-ray) could should be performed a number of days earlier than surgical procedure. Seek the advice of your major care doctor about stopping sure medicines and guarantee you’re cleared for surgical procedure.

Cease taking all non-steroidal anti-inflammatory medicines (ibuprofen, naproxen, and many others.) and blood thinners (Coumadin, aspirin, Plavix, and many others.) 7 days earlier than surgical procedure. Cease utilizing nicotine and ingesting alcohol 1 week earlier than and a pair of weeks after surgical procedure to keep away from bleeding and therapeutic issues.

If image-guided surgical procedure is deliberate, an MRI will likely be scheduled earlier than surgical procedure. Fiducials (small markers) could also be positioned in your brow and behind the ears. The markers assist align the preoperative MRI to the picture steering system. The fiducials should keep in place and can’t be moved or eliminated previous to surgical procedure to make sure the accuracy of the scan.

It’s possible you’ll be requested to scrub your pores and skin and hair with Hibiclens (CHG) or Dial cleaning soap earlier than surgical procedure. It kills micro organism and reduces surgical web site infections. (Keep away from getting CHG in eyes, ears, nostril or genital areas.)

Morning of surgical procedure

  • No meals, drink, gum or sweet.
  • Bathe utilizing antibacterial cleaning soap. Gown in freshly washed, loose-fitting clothes.
  • Put on flat-heeled sneakers with closed backs.
  • When you have directions to take common medicine the morning of surgical procedure, achieve this with small sips of water.
  • Take away make-up, hairpins, hair extensions / weaves, contacts, physique piercings, nail polish, and many others.
  • Depart all valuables and jewellery at dwelling.
  • Carry a listing of medicines with dosages and the occasions of day often taken.
  • Carry a listing of allergic reactions to medicine or meals.

Sufferers are admitted to the hospital the morning of surgical procedure. The nurse will clarify the preoperative course of and focus on any questions you could have. An anesthesiologist will speak with you to clarify the consequences of anesthesia and its dangers.

What occurs throughout surgical procedure?

Relying on the underlying downside being handled, the surgical procedure can take 3 to five hours or longer.

Step 1: put together the affected person You’ll lie on the working desk and be given normal anesthesia. As soon as you’re asleep, your head is positioned in a 3-pin cranium fixation gadget that attaches to the desk and holds your head completely nonetheless throughout surgical procedure (Fig. 2). A brain-relaxing drug referred to as mannitol could also be given.

Determine 2. The affected person’s head is positioned in a three-pin Mayfield cranium clamp which holds the top completely nonetheless throughout delicate mind surgical procedure. The hair is shaved alongside the pores and skin incision line (dashed line).

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If image-guidance is used, your head will likely be registered with the infrared cameras to correlate the “actual affected person” to the 3D laptop mannequin created out of your MRI scans. The system capabilities as a GPS to assist plan the craniotomy and find the lesion. Devices are detected by the cameras and displayed on the pc mannequin.

Step 2: make a pores and skin incision The incision space of the scalp is prepped with an antiseptic. Pores and skin incisions are often made behind the hairline. A hair sparing approach is used, the place solely a 1/4-inch broad space alongside the proposed incision is shaved. Typically all the incision space could also be shaved.

Step 3: carry out a craniotomy, open the cranium The pores and skin and muscle mass are lifted off the bone and folded again. Subsequent, small burr holes are made within the cranium with a drill. The burr holes enable entrance of a particular noticed referred to as a craniotome. Much like utilizing a jigsaw, the surgeon cuts a top level view of a bone window (Fig. 3). The minimize bone flap is lifted and eliminated to reveal the protecting overlaying of the mind referred to as the dura. The bone flap is safely put aside and will likely be changed on the finish of the surgical procedure.

Determine 3. A craniotomy is minimize with a particular noticed referred to as a craniotome. The bone flap is eliminated to disclose he protecting overlaying of the mind referred to as the dura.

Step 4: expose the mind The dura is opened to reveal the mind (Fig. 4). Retractors could also be used to softly open a hall between the mind and cranium. Surgeons use magnification glasses (loupes) or an working microscope to see the fragile nerves and vessels.

Determine 4. The dura is opened and folded again to reveal the mind.

Step 5: appropriate the issue Enclosed contained in the bony cranium, the mind can’t be simply moved apart to entry and restore issues. Neurosurgeons use quite a lot of very small devices to work deep contained in the mind. These embody long-handled scissors, dissectors and drills, lasers, and ultrasonic aspirators (makes use of a high-quality jet of water to interrupt up tumors and suction up the items). In some circumstances, evoked potential monitoring is used to stimulate particular cranial nerves whereas the response is monitored within the mind. That is performed to protect perform of the nerve throughout surgical procedure.

Step 6: shut the craniotomy After the issue has been eliminated or repaired, any retractors are eliminated, and the dura is closed with sutures. The bone flap is put again in its unique place and secured to the cranium with titanium plates and screws (Fig. 5). The plates and screws stay completely to help the world, and so they typically could be felt beneath your pores and skin. A drain could also be positioned beneath the pores and skin for a few days to take away blood or fluid from the world. The muscle mass and pores and skin are sutured again collectively. A delicate adhesive dressing is positioned over the incision.

Determine 5. The bone flap is changed and secured to the cranium with tiny plates and screws.

What occurs after surgical procedure?

You might be taken to the restoration room the place very important indicators are monitored as you awake from anesthesia. You’ll have a sore throat from the tube used to help your respiration. After you awaken, you’ll be moved to the intensive care unit (ICU) for shut monitoring. You might be incessantly requested to maneuver your arms, fingers, toes, and legs. A nurse will examine your pupils with a flashlight and ask questions, resembling “What’s your identify?” It’s possible you’ll expertise nausea and headache after surgical procedure. Treatment can management these signs. Relying on the kind of mind surgical procedure, steroid medicine (to regulate mind swelling) and anticonvulsant medicine (to forestall seizures) could also be given. When your situation stabilizes, you’ll be transferred to a daily room the place you’ll start to extend your exercise degree.

The size of the hospital keep varies, from solely 2-3 days or 2 weeks relying on the surgical procedure and any problems. When launched from the hospital, you’ll be given discharge directions.

Observe the surgeon’s dwelling care directions for 2 weeks after surgical procedure or till your follow-up appointment. Normally, you may count on:


  • Don’t raise something heavier than 5 kilos.
  • No strenuous exercise together with yard work, house responsibilities, and intercourse.
  • Don’t drink alcohol. It thins the blood and will increase the danger of bleeding. Additionally, don’t combine alcohol with ache medicines.
  • Don’t smoke or use nicotine merchandise: vape, dip, or chew. It might delay therapeutic.
  • Don’t drive, return to work, or fly air journey till your surgeon says it’s OK.

Incision Care

  • It’s possible you’ll bathe the day after surgical procedure and wash your hair with gentle child shampoo. Gently wash the incision space with cleaning soap and water on daily basis. Don’t scrub or let the water beat laborious in your incision. Pat dry.
  • If Dermabond pores and skin glue covers your incision, don’t rub or decide on the glue.
  • Don’t submerge or soak the incision in a shower, pool or tub. Don’t apply lotion/ointment on the incision, together with hair styling merchandise.
  • It’s possible you’ll hear unusual noises (popping, crackling, ringing) inside your head. That is regular therapeutic as air and fluid reabsorb.
  • Don’t coloration your hair for six weeks. Should you minimize your hair, use warning close to the incision.


  • Complications are widespread after surgical procedure. It’s possible you’ll take acetaminophen (Tylenol).
  • Take ache medicines as directed by your surgeon. Scale back the quantity and frequency as your ache subsides. Should you don’t want the ache drugs, don’t take it.
  • Narcotics may cause constipation. Drink numerous water and eat high-fiber meals. Stool softeners and laxatives will help transfer the bowels. Colace, Senokot, Dulcolax and Miralax are over-the-counter choices.
  • Anti-seizure drugs could also be prescribed. Some sufferers develop uncomfortable side effects resembling drowsiness, steadiness issues, or rashes. Name the workplace if any of those happen.
  • Don’t take anti-inflammatory ache relievers (Advil, Aleve), blood thinners, or dietary supplements with out surgeon’s approval.


  • Rise up and stroll 5-10 minutes each 3-4 hours. Regularly enhance strolling as you’re able.
  • Swelling and bruising of the attention or face could happen. It should take a number of weeks to go away.
  • Sleep along with your head elevated and apply ice 3-4 occasions per day for 15-20 minutes to assist cut back ache and swelling.

When to Name Your Physician

  • Fever over 101.5º (unrelieved by Tylenol).
  • Indicators of incision an infection, resembling spreading redness, separation, or coloured drainage.
  • Elevated drowsiness, weak point of arms / legs, elevated complications, vomiting, or extreme neck ache that forestalls decreasing your chin to chest.
  • New or worsening imaginative and prescient, speech or confusion.
  • Swelling on the incision with leaking of clear fluid out of your ear or nostril.
  • Swelling and tenderness within the calf of 1 leg.
  • Seizure


A follow-up appointment is made 10 to 14 days after surgical procedure. The restoration time varies from 1 to 4 weeks relying on the underlying illness being handled and your normal well being. Full restoration could take as much as 8 weeks. Strolling is an efficient approach to start growing your exercise degree. Don’t overextend your self, particularly in case you are persevering with therapy with radiation or chemotherapy. Ask your surgeon when you may count on to return to work.

What are the dangers?

No surgical procedure is with out dangers. Common problems of any surgical procedure embody bleeding, an infection, blood clots, and reactions to anesthesia. Particular problems associated to a craniotomy could embody stroke, seizures, swelling of the mind, nerve injury, cerebrospinal fluid leak, and lack of some psychological capabilities.

What are the outcomes?

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The outcomes of your craniotomy depend upon the underlying situation being handled.

When you have extra questions, please contact Mayfield Mind & Backbone at 800-325-7787 or 513-221-1100.


biopsy: a pattern of tissue cells for examination beneath a microscope to find out the existence or explanation for a illness.

burr gap: a small dime-sized gap made within the cranium.

cerebrospinal fluid (CSF): a transparent fluid produced by the choroid plexus within the ventricles of the mind that bathes the mind and spinal wire giving them help and buoyancy to guard from damage.

craniectomy: surgical removing of a portion of the cranium.

craniotome: a particular noticed with a footplate that permits slicing of the cranium with out slicing the dura mater.

craniotomy: surgical opening of a portion of the cranium to achieve entry to the intracranial constructions and alternative of the bone flap.

dura mater: the outer protecting overlaying of the mind.

endoscopic-assisted surgical procedure: a process utilizing a probe (endoscope) fitted with a tiny digicam and light-weight, which is inserted by a small keyhole craniotomy to take away a tumor.

laser: a tool that emits a slim intense beam of vitality to shrink and minimize tissue.

lesion: a normal time period that refers to any change in tissue, resembling tumor, blood, malformation, an infection or scar tissue.

minimally invasive surgical procedure: use of expertise (e.g., endoscopes, cameras, image-guidance programs, robotics) to function by small, keyhole incisions within the physique.

image-guided surgical procedure: use of preoperative CT or MRI scans and a pc workstation to information surgical procedure.

seizure: uncontrollable convulsion, spasm, or collection of jerking actions of the face, trunk, arms, or legs.

shunt: a drainage tube to maneuver cerebrospinal fluid from contained in the ventricles of the mind into one other physique cavity (e.g., stomach).

stroke: a situation brought on by interruption of the blood provide to the mind; could trigger lack of potential to talk or to maneuver components of the physique.

stereotactic: a exact technique for finding deep mind constructions by way of three-d coordinates.

ultrasonic aspirator: a surgical instrument that makes use of a high-quality jet of water, ultrasonic vibration, and suction to interrupt up and take away lesions.

up to date > 1.2021 reviewed by > Vince DiNapoli, MD, PhD, Yair Gozal, MD, PhD, Mayfield Clinic, Cincinnati, Ohio

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