Craniotomy

A craniotomy is the surgical removal of part of the bone from the skull to expose the brain. Specialized tools are used to remove the section of bone called the bone flap. The bone flap is temporarily removed, then replaced after the brain surgery has been done. 

Some craniotomy procedures may use the guidance of computers and imaging (magnetic resonance imaging [MRI] or computerized tomography [CT] scans) to reach the precise location within the brain that is to be treated. This technique requires the use of a frame placed onto the skull or a frameless system using landmarks on the scalp. When either of these imaging procedures is used along with the craniotomy procedure, it is called a stereotactic craniotomy. 

Scans made of the brain during this procedure provide a three-dimensional image of what the brain structure looks like. For example, your provider would be able to see a tumor within the brain with these scans. It is useful in making the distinction between tumor tissue and healthy tissue and reaching the precise location of the abnormal tissue.

Because a craniotomy is so useful for viewing the structure of the brain, there are many reasons a doctor may recommend one, including: 

• 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 head injury or stroke 
• Treating epilepsy 
• Implanting stimulator devices to treat movement disorders or dystonia (a type of movement disorder)

As with any surgical procedure, complications may occur. Brain surgery risk is tied to the specific location in the brain that the operation will affect. For example, if the area of the brain that controls speech is operated on, then speech may be affected. Some more general complications include: 

• 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) 
• Risks associated with the use of general anesthesia 

The following complications are rare and generally relate to specific locations within the brain, so the risk depends on the individual undergoing the procedure: 

• 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 before the procedure. 

You can help make sure your child has the best possible surgery outcome by understanding what to expect before, during and after a craniotomy at Gillette Children’s. Here are a few resources to help you feel more prepared: 

• Review tips to prepare for surgery at Gillette 
• Understand the amenities available at Gillette 

A Week Before Surgery  

A week before the surgery, we will contact you to: 

• Gather a health history, including details about medicines (name, dose, frequency), pharmacy and primary care doctor. 
• Discuss what to expect on the day of surgery and during the hospital stay. 
• Let you know what you’ll need when your child leaves the hospital. 

Maintain a Healthy Diet and Regular Activity 

Overall health can affect how well and how quickly your child recovers from surgery. In general, kids should maintain regular levels of activity and physical therapy leading up to surgery. 

Before and after the surgery, make sure your child eats enough food with iron, calcium, and vitamins C and D. Fresh colorful fruits and vegetables, dairy food, and other products with added iron and calcium offer great ways to get these nutrients. 

Manage Stress 

Sometimes fears, behavior or expectations related to upcoming surgery can cause stress for families. Contact your child’s primary health care provider or Gillette Child and Family Services for support. 

We can also help with resources that might reduce anxiety for your family. Our child life specialists can provide emotional support and distractions, such as toys and movies in the waiting area before surgery begins. Child life specialists can also meet with your child’s siblings to address their feelings and concerns. 

Knowing what to expect can help everyone feel more prepared. We’ll take time to clarify all expectations, including the long-term side effects of craniotomy surgery.

The Day of Surgery 

The perianesthesia (presurgery) staff welcomes you when you arrive. We weigh your child and ask them to change into a hospital gown. We also check temperature, pulse and blood pressure. A child life specialist helps your child feel more at ease with toys, crafts or movies. 

Next, you and your child meet with the surgery team, which includes: 

• Pediatric neurosurgeon 
• Nurse anesthetist 
• Anesthesiologist 
• Nurses 

This is a chance for you to raise any questions or concerns. The anesthesiologist discusses how anesthesia and pain medicine are used during surgery. You can talk about your child’s experiences with pain and request medicine or other techniques to help them relax. 

Surgery 

A craniotomy takes place under general anesthesia, which means you’re asleep throughout the procedure. Your neurosurgeon will perform a craniotomy, opening the skull to access the brain. 

During the procedure, your surgeon: 

• Removes a piece of your skull 
• Peels back a section of the dura, the tough membrane that protects the brain 
• Uses surgical microscopes to insert special instruments to remove or cut pieces of brain tissue based on the reason for craniotomy 
• Replaces the dura 
• Uses stitches or staples to secure the skull bone back into place

How long does a craniotomy take? It depends, but usually between 2.5-3 hours.

Rehabilitation and Craniotomy Recovery 

Every child heals differently, and outcomes depend on the neurologic condition of your child before surgery.  

A craniotomy generally requires a hospital stay of 3 to 7 days. You may also go to a rehabilitation unit for several days after your hospital stay. Procedures may vary depending on your condition. 

After the craniotomy, your child will spend one to three days in the pediatric intensive care unit (PICU) for close monitoring.

If your child experiences seizures or has epilepsy, we offer complete diagnostic services and a team of experts to provide comprehensive care, beginning with a first seizure evaluation by experts in nursing and neurology (pediatric neurologists, epileptologists, and neurology nurse practitioners).

As your child grows into their teen years and adulthood, we’ll continue to work closely with your family to provide the most effective management and best care for epilepsy and seizures. Over the course of treatment, your child might receive care from providers in the following specialties and services:

• Neurosurgery
• Neurology
• Pediatric Rehabilitation Medicine
• Neuropsychology
• Child life
• Psychiatry
• Psychology
• Rehabilitation therapies
• Radiology and imaging
• Social work

You can trust your child’s care to our expertise in treatment of epilepsy and seizures. As a regional leader in pediatric neurology and neurosurgery, we understand that many kids who have epilepsy also have complex associated conditions, such as cerebral palsy, developmental delays or traumatic brain injuries. That’s why we offer a large team of specialists and extensive support services.