A craniectomy is a surgical procedure in which a section of the skull (bone flap) is removed in order to reduce pressure on the underlying brain tissue. The skilled team at Neuroscience Specialists offers expert care for a wide range of brain and spine conditions in Oklahoma City, OK. We also provide specialized aftercare to improve outcomes. Contact our office for an appointment today.
What is Craniectomy?
A craniectomy is a surgical procedure in which a section of the skull (bone flap) is removed in order to reduce pressure on the underlying brain tissue. In a craniectomy, the bone flap is not replaced immediately. Instead, the defect is usually covered with a skin flap. Craniectomy is usually performed when an individual has sustained a serious brain injury or trauma that has caused excessive swelling of the brain or significant bleeding around the brain necessitating immediate intervention. If left untreated, bleeding or pressure can compress the brain and force it down towards the brainstem. This can be life-threatening or lead to permanent brain damage.
Indications for Craniectomy
The main indications for craniectomy are intracranial pressure (ICP), intracranial hemorrhage, and intracranial hypertension (ICHT). These may occur as a result of conditions such as:
- Traumatic brain injuries
- Blood clots in arteries of the brain
- Cerebral edema (accumulation of fluid in the brain)
- Intracranial hematoma (accumulation of blood inside the skull)
- Cerebral infarction or stroke
- Meningitis (inflammation of the brain)
- Hydrocephalus (collection of spinal fluid in the brain cavities)
Preparation for Craniectomy
Pre-procedure preparation for craniectomy will involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a week before surgery.
- You should not consume any solids or liquids at least 8 hours before surgery.
- You will be instructed to shower with an antibacterial soap the morning of surgery to help lower your risk of infection after surgery.
- You need to take off any jewelry, clothing, or other objects that may obstruct the procedure and wear a hospital gown.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the pros and cons of the surgery have been explained in detail.
Procedure for Craniectomy
Depending on the underlying condition being treated, a craniectomy surgery may take 3 to 5 hours or longer and is usually performed under general anesthesia. In general, the procedure involves the following steps:
- You will be placed on the operating table in a way that gives your surgeon the best access to the portion of the brain to be operated on.
- Your head will be shaved and the surgical site will be cleaned with an antiseptic solution.
- Your head will be held in position by a Mayfield head holder or a similar device until the end of the surgery.
- Based on the location of the treatment area, an incision is made accordingly to remove the portion of the skull. Your surgeon may use special instruments such as a medical drill and a saw to make burr holes and cut the skull bone respectively.
- The dura mater (outer covering of the brain) under the skull is cut open to expose the brain and the dura folds are secured with retractors.
- Your surgeon performs the required treatment such as removal of a blood clot, abscess, aneurysm, or tumor accordingly to achieve decompression.
- Once the treatment is complete, the retractors are removed, the layers of tissue are stitched together, and a temporary skin flap is used to cover the defect. The brain typically experiences significant swelling after a severe injury. Hence, it is advisable to allow the brain swelling to subside over time and then replace the defect with a bone flap or a prosthetic covering subsequently.
- The skin incision is finally closed with surgical staples or stitches, and a sterile dressing or bandage is applied to complete the operation.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after a craniectomy will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover. Frequent neurological checks will be performed by your medical staff to assess your brain function.
- The length of hospital stay varies from 2 to 3 days to a week or more depending on the patient’s condition.
- You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Application of cold and warm compresses on the operated area is also recommended to reduce inflammation and pain.
- Antibiotics are prescribed as needed to address the risk of surgery-related infection.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking and alcohol for a specific period of time as it can negatively affect the healing process.
- Gentle neck stretches and regular walking is recommended to improve strength and endurance.
- Refrain from strenuous activities and lifting anything heavier than 5 pounds until the first follow-up visit. These activities include housework, yard work, gardening, mowing, etc.
- Gradual increase in activities over a period of time is recommended. You may take many weeks to return to your previous level of strength and energy.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Craniectomy is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Blood clots or deep vein thrombosis
- Anesthetic/allergic reactions
- Brain damage
- Brain death
- Full/partial-body paralysis
- Blood pressure fluctuation
- Decline in some mental functions