Craniotomy Tumour Surgery | Brain Tumour Expert Prof Brian Owler

What is a craniotomy?

A craniotomy is a neurosurgical procedure whereby an area of the skull is removed to create a window through which the brain and the surrounding structures may be accessed. At the end of the procedure the area of the skull that has been removed, that is, the bone flap, is replaced and secured using small titanium plates and screws. Any bony defect around the bone flap is also filled with a bone substitute.

There are many types of craniotomies that can be performed depending on the nature of the pathology and its location. These are named after the area of skull that is being removed. For example, a frontal craniotomy involves removal of part of the frontal bone.

Craniotomies are performed not only to remove tumours of the brain but also for a range of other pathologies such as removal of a blood clot or haemorrhage or, clipping of an aneurysm. The time taken to perform a craniotomy will depend on the reason why it is performed.

Most craniotomies, especially for tumours, are performed with the assistance of an image guidance system. This is known as a stereotactic craniotomy. Prior to the surgery an MRI scan is performed. Small dots are attached to the patients scalp for the scan. These are known as fiducials. The MRI images are then uploaded to the IGS and once the patient is positioned for surgery, the fiducials on the patient are matched to the fiducials in the images. As a result, the neurosurgeon can use a small probe and point to any structure on the skull or within the brain. The images are shown on screen in the operating theatre and the neurosurgeon can then see where the probe is in relation to the scans.

The use of the image guidance system is a standard part of tumour removal. It allows the incision to be placed directly over the tumour making the incision smaller and the craniotomy smaller. The IGS can also be used to guide the surgeon to the pathology as well as indicate the extent of resection. It makes the surgery safer and more effective for the patient.

Related conditions to craniotomy

Adult Brain Tumours

Paediatric Brain Tumours

Meningiomas

What are the risks of a craniotomy?

The risks are dependent on the nature of the pathology for which the surgery is being performed and the nature of the surgery that is being performed in or around the brain. The risks will also depend on the location in which the surgery is being performed. When surgery is performed to remove tumours close to important structures or a region of the brain with an important function, then there is a risk of impairing that function. These specific risks are discussed prior to the surgery.

There are general risks associated with a craniotomy. These risks include those normally associated with surgery such as bleeding or infection, DVT or pulmonary embolism, and the risks associated with a general anaesthetic. Surgery in or around the brain also has specific risks, such as those of seizures or epilepsy as well as neurological deficits from stroke or haemorrhage.

What occurs after the surgery?

At the end of the operation, most patients are recovered, that is woken-up and the breathing tube removed just like any other general anaesthetic. The patient is then assessed in terms of their neurological function and transferred to the intensive care unit where they are closely observed. After a few hours, the patient can normally start to eat and drink.

The following day the patient usually undergoes a CT or MRI scan. If they are well then, they are transferred to a normal ward bed. Observations are still performed but less frequently. Depending on the patient’s condition and their clinical progress, most patients are able to be discharged home. The average length of stay in hospital is 4- 7 days.

When the craniotomy is performed for removal of a tumour, a specimen is sent for histological analysis. This is important in confirming the type of tumour. The results are normally available in less than one week. If the tumour is likely to require other treatments, then these referrals and arrangements are made prior to discharge.

What follow-up is required after surgery?

The scalp is normally closed using skin clips. These need to be removed 7-10 days after the surgery, and patients are asked to return to their GP for removal of the clips. This also provides an opportunity for the wound to be reviewed by their doctor.

Patients are encouraged to return to see Prof Owler around 4-6 weeks after the surgery to ensure that the recovery is proceeding as planned and discuss any concerns. An appointment will be made for you shortly after the procedure has been performed.

Important Information

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Craniotomy for Tumour