Neurology Associates, P.C.

Surgery
Brain Surgery (Craniotomy)

Brain surgery is a procedure performed by neurosurgeons to treat problems in the brain and the surrounding structures (It is also referred to as craniotomy or craniectomy.)

Brain surgery may be performed to treat the following conditions:

  • Brain tumor
  • Bleeding in the brain (cerebral hemorrhage)
  • Blood clots in the brain (subdural hematoma)
  • Weaknesses in blood vessels (cerebral aneurysm)
  • Abnormal blood vessels in the brain (arteriovenous malformations)
  • Damage to tissues covering the brain (dura)
  • Infections in the brain (brain abscesses)
  • Severe nerve or face pain (such as trigeminal neuralgia or tic douloureux)
  • Skull fracture
  • Pressure in the brain after traumatic brain injury or stroke
  • Epilepsy
  • Parkinson’s disease or epilepsy for the insertion of electronic devices

Steps During Brain Surgery

Craniotomy - Brain SurgeryBefore surgery, the hair on part of the scalp is shaved, and the area is cleaned. The doctor makes a surgical cut through the scalp. The location of this cut depends on where the problem in the brain is located.

The surgeon creates a hole in the skull and removes a piece, called a bone flap.

If possible, the surgeon will make a smaller hole and insert a tube with a light and camera on the end. This is called an endoscope. The surgery will be done with tools placed through the endoscope. MRI or CT can help guide the doctor to the proper place in the brain.

The following steps depend on the procedure being performed and the portion of the brain being treated. For example, the neurosurgeon may put a clip on a blood vessel to treat a cerebral aneurysm, remove fluid from a hematoma, or biopsy a portion of tissue.

The duration of surgery depends on the problem being treated.

The bone flap is usually replaced after surgery, using small metal plates, sutures, or wires. The bone flap may not be put back if your surgery involved a tumor or an infection, or if the brain was swollen.

Risks of Brain Surgery

Surgery on any one area may cause problems with speech, memory, muscle weakness, balance, vision, coordination, and other functions. These problems may last a short while or they may not go away.

  • Possible risks of brain surgery are:
  • Blood clot or bleeding in the brain
  • Seizures
  • Stroke
  • Coma
  • Infection in the brain, in the wound, or in the skull
  • Brain swelling

Preparing for Brain Surgery

Before Brain Surgery

Your doctor will examine you, and may order laboratory and x-ray tests.

Always tell your doctor or nurse:

  • If you could be pregnant
  • What drugs you are taking, even drugs, supplements, vitamins, or herbs you bought without a prescription
  • If you have been drinking a lot of alcohol
  • If you take aspirin or anti-inflammatory drugs such as ibuprofen
  • If you have allergies or reactions to medications or iodine

During the days before the surgery

  • You may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • Ask your doctor which drugs you should still take on the day of the surgery.
  • Always try to stop smoking. Ask your doctor for help.
  • Your doctor or nurse may ask you to wash your hair with a special shampoo the night before surgery.

On the day of the surgery

  • You will usually be asked not to drink or eat anything for 8 to 12 hours before the surgery.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

After Surgery

After surgery, you'll be closely monitored by your health care team to make sure your brain is working properly. The doctor or nurse may ask you questions, shine a light in your eyes, and ask you to do simple tasks. You may need oxygen for a few days.

The head of your bed will be kept raised to help reduce swelling of your face or head, which is normal.

You will probably be given medications to relieve pain.

You will usually stay in the hospital for 3 to 7 days. You may need physical therapy (rehabilitation).

How well you do after brain surgery depends on the condition being treated, your general health, which part of the brain is involved, and the specific type of surgery.


Reference: The National Institute of Neurological Disorder and Stroke.