Understanding Craniotomy

What is a craniotomy?

If you need brain surgery for treatment of a neurological condition, your neurosurgeon will need to temporarily remove a piece of your skull. This procedure, called a craniotomy, exposes the specific portion of your brain that needs treatment.

Although your skull must normally remain intact in order to protect your brain, a craniotomy is a necessary first step during many life-changing or lifesaving surgical treatments, including:

• clipping or repairing brain aneurysms
• removing a brain tumor
• removing tangled blood vessels that are not properly connected (a condition called arteriovenous malformation)
• removing a blood clot from the brain
• draining a brain abscess, or a portion of the brain that has become infected and inflamed
• relieving pressure that has built up inside of the brain due to illness or injury
• procedures to help control seizures
• implanting devices that help people manage symptoms of Parkinson's disease or other movement disorders

Your Lyerly neurosurgeon will decide what part of your skull to open, and how much bone to remove, based on the procedure he will perform once he has access to your brain.

Following surgery, the portion of your skull that has been removed will be fitted back into its original place. Although this usually occurs immediately after surgery, in some cases the piece of bone is stored and placed back into the skull at a later date.

Preparing for brain surgery with craniotomy

First, your neurosurgeon will confirm whether you are healthy enough for surgery. He will perform a thorough medical examination, review your medical history and, if necessary based on your current health status, order additional tests.

If you are approved for surgery, you will need to complete a consent form giving your Lyerly physician permission to perform the procedure. Please read the form carefully, and make sure to let your doctor know if you have questions or concerns.

The following general guidelines apply to most people who are scheduled to have brain surgery with a craniotomy. Your doctor or another clinician from Lyerly Neurosurgery may give you additional instructions.

• If you are a smoker, you must not smoke for at least seven days prior to your surgery. This will help reduce your risk of complications. Please let your doctor know if you need help with smoking cessation.
• The night before your surgery, you should not eat or drink anything after midnight.
• The morning of your surgery, do not take any prescription or over-the-counter medications that can increase bleeding risk. These include blood thinners and nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen and naproxen).
• If you use other daily prescription medications, you may be able to take them as usual the morning of your surgery — your doctor will let you know what is safe to use.
• Unless instructed otherwise, your craniotomy and subsequent brain surgery will take place at Baptist Medical Center Jacksonville. Please check in at the registration area located on the first floor of the Wayne and Delores Barr Weaver Tower. You will be given detailed instructions on what time to arrive and where to park.
• Bring your prescription or over-the-counter medications with you to the hospital, in their original containers.
• Don't forget to notify our team if you have a history of bleeding disorders, or if you are allergic (or have a sensitivity) to any medications, anesthesia, latex or adhesive tape.

What to expect after your surgery

The average length of stay in the hospital following a craniotomy and brain surgery is three to five days.

Immediately after surgery, you will be monitored closely by your doctor and his health care team. First you'll be taken to a recovery area for short term observation, and then you will be transferred to a bed in the intensive care unit (ICU) for continued surveillance. When you no longer require intensive care, you will be moved from the ICU to a standard inpatient room.

Throughout your stay in the hospital, members of your health care team will perform frequent small tests to check your brain function. These tests may include your ability to follow commands (such as moving an arm or leg), or your ability to count.

Your dietary needs will be tailored to the progress you make during recovery. You'll start with a liquid diet and, once you can tolerate them, progress to eating solid foods.

Before you are discharged from the hospital, members of your health care team will help guide you through your transition to home. They will make sure you understand what medications to take, and when you may resume bathing, driving and physical activity. Prior to leaving the hospital, you also will schedule a follow-up appointment with your neurosurgeon.

Your doctor or another member of the Lyerly Neurosurgery team will give you detailed instructions for taking care of yourself once you're home. However, the following general guidelines apply to most people:

• It is normal to have pain and discomfort around the incision on your head. You may notice the pain worsen when you cough, take a deep breath or exert yourself. Your doctor will talk to you about pain medications that are safe to use.
• Make sure to keep your incision clean and dry.
• If your incision was closed with stitches or staples, your doctor will remove them during your follow-up appointment. If your incision was closed with adhesive strips, they will fall off on their own.
• Avoid tobacco smoke and other substances that might irritate your respiratory system.

While you are recovering at home, pay attention to any unusual symptoms. Call our office at 904.861.0316 if you experience any of the following:

• fever
• redness, swelling, bleeding or drainage from your incision
• pain that gets worse over time, or cannot be managed with pain medication
• vision changes
• excessive fatigue

If you suddenly experience any of the following symptoms that may indicate a medical emergency, please call 911:

• difficulty breathing
• trouble speaking, including slurred speech
• confusion, including trouble understanding speech
• sudden weakness in an arm or leg, especially on one side of the body
• seizures

Are there any risks I should be aware of?

As with any surgical procedure, a craniotomy is associated with rare but serious risks. There also may be separate risks associated with the procedure your doctor will perform once your brain is exposed for treatment.

Some risks are specific to each patient, and depend on the area of the brain being operated on. This is because different areas of the brain help control different functions, including speech, vision and muscle control.

Other risks are more general in nature, and can affect anyone undergoing a brain surgery with craniotomy. These include:

• an infection at the site of your incision
• a torn or damaged blood vessel that causes blood to leak into the brain
• damage to the membrane surrounding the brain and spinal cord, which can cause cerebrospinal fluid to leak (and affect brain pressure)
• brain swelling
• seizures
• pneumonia
• a blood clot in one of your blood vessels, which can increase your risk of stroke
• pulmonary embolism, which occurs when a blood clot blocks one of the arteries in your lungs
• coma
• death

The region's trusted brain surgery experts

We understand how important it is for you to have confidence in your neurosurgeon.

Since Lyerly Neurosurgery was founded in 1934, our physicians have cared for thousands of people who need treatment for a brain or spine condition.

Today our practice continues to build upon a legacy that blends compassion, safety and innovation. Our neurosurgeons provide the full spectrum of evidence-based care, including the latest minimally invasive procedures that can only be offered by neurosurgeons with advanced training and experience.

If you or a loved one needs brain surgery, you'll find the care and support you need at Lyerly Neurosurgery. In partnership with Baptist Medical Center Jacksonville, our team provides emergency and preventive surgical treatment for most neurological conditions.