Craniotomy

• The physician of the patient will explain the entire procedure, offer opportunity to ask questions, and request for consent to perform the surgery by signing a form. The patient should read the form carefully and ask questions wherever in doubt.
• The patient will be asked to enlighten on the complete medical history, and current medications being undertaken. Physical examination is done for ensuring that the patient is in good health prior to the surgery.
• Blood tests and other diagnostic tests of the patient will be required.
• A pre-operative neurological examination will be carried out on the patient that would be used to compare with the report generated after the examination.
• Fastening will be required, almost 8 hours prior to the surgery. (Usually after midnight)
• Pregnancy or even suspicion of pregnancy should be informed to the physician.
• Sensitivity or allergic reactions to any medication should be informed to the physician. Even if the patient is taking any medication or consuming herbal supplements, it should be informed. Every minute detail plays a vital role prior to the procedure.
• Smoking should be immediately stopped before the procedure in order to ensure swifter recovery.
• The patient might be asked to wash hair using a special antiseptic shampoo a night prior to the surgery.
• A sedative will be provided before the surgery is carried out to help the patient relax.
• The surgical site and the areas around will be shaved.
• Other specific preparations may be requested by the patient on the basis of the medical condition of the patient.

A hospital stay of around three to seven days is required during a craniotomy. Procedures may vary depending on the condition of the patient and the practices of the physician. A craniotomy follows the following process:

• All sorts of jewellery will have to be removed, and an operation gown will have to be worn. Emptying of the bladder will be required.
• To inject medication and administer fluids, an intravenous (IV) line will be inserted into the patient’s arm. Moreover, to drain the patient’s urine, a urinary catheter will be attached.
• The patient will be placed in a position that allows the maximum access to the problem area in the brain.
• The heart rate, breathing rate, blood pressure, etc., of the patient, will be continuously monitored.
• The patient’s head will be shaved, and cleansing of the skin over the surgical area will be done using an antiseptic solution.
• Depending on the area of the problem and the affected site of the brain, a specific type of incision will be used.
• To control bleeding, the scalp will be pulled up and clipped. However, access will be provided to the brain.
• In order to proceed with making burr holes in the skull, a medical drill may be used. Further, surgical saw shall be utilized to cautious cut the bone. The flap of the bone will be removed and preserved.
• The dura mater, (a thick outer covering right beneath the bone) will be separated from the bone and cautious and smoothly cut open to make the brain visible.
• If required, excess fluid of the brain will be made to flow out. Samples of tissue might also be sent to the laboratory for testing.
• To measure the inside pressure or (ICP) of the skull, a device shall be placed in the brain tissue.
• As soon as the surgery gets over, the surgeon sews the layers of tissue together. Then, using plates, sutures, or wires the bone flap is reattached.
• If an infection or a tumour is found in the bone, the replacement of the flap shall not be done.
• The skin incision site will be then closed. A sterile dressing will provided over the incision.

• Immediately after the procedure, the patient is taken for observation to a recovery room. Post the observation is complete; the patient is then taken to the ICU for a further close monitoring or in some cases the patient directly brought to the ICU.
• The patient might be required to breathe through an oxygen mask for some time after the surgery.
• As soon as the patient’s blood pressure, pulse, and breathing rate become stable, he/she is shifted to a room on the neurosurgical nursing unit of the hospital.
• The patient would be required to stay in the hospital for several more days after the surgery.
• In order to prevent pneumonia, the patient will be taught deep-breathing exercises that will assist in re-expanding the lungs.
• Further, to check if the brain of the patient is functioning properly after the surgery and to ensure that the other senses of the patient are functioning properly, frequent neurological checks will be done by the medical professionals at the hospital.
• Some swelling is usually normal; however, the head side of the patient’s bed will always be kept elevated to prevent excessive swelling of the face and head.
• The patient will be encouraged to move around, with help at first, and as the strength improves without any help.
• Exercises will be suggested to the patient by a physical therapist (PT). The therapist may also be asked to evaluate the patient’s strength, balance, and movements.
• In order to prevent blood clot in the legs while the patient is in the bed, sequential compression devices (SCDs) are likely to be placed on the legs.
• Based on the condition of the patient, he/she will be given some liquid to consume after few hours of the surgery. Solid food will be gradually added to the patient’s diet.
• The catheter will remain attached to the bladder of the patient to drain urine for at least a day after the surgery or till the time the patient is comfortable enough to move around. If any painful urination takes place after the catheter is removed, the same should be immediately informed to the doctor.
• Based on the condition of the patient, he/she might be transferred a rehabilitation facility for assisting in regaining strength.
• Prior to the discharge, the patient will be informed about the follow-up visits, medication to be taken at home and will be provided with important instructions for home care.

Some general complications of this procedure are mentioned below. But, the risks are not limited to the following:

• Seizures
• Bleeding
• Infection
• Blood clots
• Pneumonia
• Unstable BP
• Brain swelling
• Muscle weakness
• Leakage of the fluid that surrounds and acts as a cushion to the brain – (cerebrospinal fluid)

These next set of complications are very rare and may not be valid for various individuals, but, are related to the above-mentioned procedure:

• Abnormal balance or coordination
• Memory problems
• Speech difficulty
• Paralysis
• Coma

Other risks might be there based on the specific medical condition of the patient. It is recommended that patient who is about to undergo this procedure clearly shares his/her concerns with the physician.