Craniotomy: A Closer Look

A craniotomy is a surgical procedure wherein an opening is created in the skull to access the brain. This is typically done by making one or more burr holes with a drill and then cutting a bone flap with a specialized saw. During the procedure, the patient’s head is securely held in a three-pin cranial fixation clamp to avoid any movement during critical stages of the operation. The goal is to perform a minimally invasive or ‘keyhole’ surgery, making the smallest necessary craniotomy to achieve optimal results while ensuring cosmetic considerations by keeping incisions behind the hairline and away from the face.

Awake Craniotomy:

In some cases, especially when lesions are near critical brain areas, patients may undergo what is known as an ‘awake craniotomy’. In this procedure, local anesthesia is used on the scalp and skull, allowing patients to interact during surgery. This method is crucial when dealing with tumors located in or near ‘eloquent’ brain areas where removal could impact vital functions, like speech.

Locating the Lesion:

Most craniotomies employ navigation assistance for precise lesion location to minimize the cut and craniotomy size. This often involves pre-surgery brain MRI and sometimes CT scans. During the operation, advanced software, monitors, and infrared cameras are used to create a three-dimensional map of the brain, assisting in a technique known as stereotactic navigation.

Keyhole Craniotomy:

The term ‘keyhole craniotomy’ doesn’t always imply a small hole. Some surgeries necessitate a larger craniotomy, especially when addressing sizable tumors on the brain’s surface. The emphasis is on utilizing the smallest possible craniotomy that allows adequate exposure without compromising surgery safety. Typically, minimal to no hair is removed, and when enclosing the skull, attention is given to avoid visible defects, using reconstructive cranioplasty techniques and materials for a seamless, cosmetic result.

Post-Surgery Experience:

Craniotomies usually aren’t exceedingly painful. Patients can anticipate waking up with a bandage around their heads, resembling a turban, which generally remains for 48 hours to mitigate swelling. The initial post-surgery night involves intensive care with regular monitoring of vital signs. A CT scan is conducted the following day to check for any complications before transferring the patient to a ward. Early mobility is encouraged post-surgery, and typically, patients can return home after four to five days.

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