Craniotomy

Craniotomy

Procedure & Recovery Overview

A craniotomy is the removal of a portion of the skull to access the brain. This neurosurgical procedure treats several conditions, including acquired brain bleeding (epidural/subdural hematoma), tumors and some brain lesions. The goal of surgery is to safely remove abnormalities or masses that put severe pressure on the brain.

What Happens During a Craniotomy?

For planned surgery, it may be possible to use navigation to assist with the procedure. Emergencies may proceed without this step. Princeton Brain, Spine & Sports Medicine prepares you for navigated cranial surgery by placing markers designed for our precision stereotactic navigation system. To assure accuracy, we may remove a small portion of your hair to make exact markings on the skull. Then, we obtain special CT or MRI imaging to provide a personalized, GPS-like map of your skull and brain.

After removing the appropriate portion of the skull, your PBSSM neurosurgeon uses an operating microscope and microsurgical techniques to safely and effectively remove the identified tumor or hematoma. The skull bone may be replaced immediately or after a few days to allow brain swelling to resolve. It is reattached using MRI-safe titanium plates and screws, and all tissue layers are sewn or stapled closed.

Preparing for a Craniotomy

1. One week before surgery, take no NSAIDs (non-steroid anti-inflammatory medications). These include Aleve, Advil, ibuprofen or Naprosyn and especially aspirin. If you are unsure whether other medicines should be taken during the week before surgery, contact the PBSSM medical staff at 609.921.9001 in New Jersey or 215.741.3141 in Pennsylvania.
2. Do not eat or drink after midnight prior to surgery. The only exception is to take normal medications with a sip of water. If you are diabetic and require insulin, please consult your Princeton Brain, Spine & Sports Medicine neurosurgical provider about taking insulin before surgery.
3. Prepare to arrive an hour before your scheduled surgery. If you arrive late, surgery may be canceled and rescheduled. Please bring your preoperative folder and relevant imaging (MRI, CT, x-ray). Note: For a craniotomy, you may need a stereotactic brain image the day before or morning of your surgery.
4. Tobacco use is detrimental to recovery and healing time. If you are a tobacco user, you must abstain two weeks before and after surgery. Lengthening tobacco abstinence or quitting altogether aids in surgical recovery and improves overall health and well-being.

FAQs About Craniotomies

My incision/wound site hurts. What’s going on?

Craniotomy pain varies from person to person. There may be mild pain at the incision site, though it is more common to experience a dull and generalized headache. Frontal or temporal surgeries may lead to pain in the jaw. Mild/moderate swelling is normal for a few days after the procedure. If you experience excessive swelling, pus or drainage at the incision site—or fever, chills or nausea—seek immediate medical attention. These could indicate an infection. Sensitivity to light and a stiff neck may accompany these signs.

How should I dress my wound? How long until I can bathe and dress normally?

• Often, a surgical drain is placed in the wound to allow normal post-operative bleeding to escape. The PBSSM team removes these before hospital discharge. Your bandage may be removed the second day after surgery. Staples and sutures should be left intact until your post-operative visit (one to two weeks post-surgery). They will be removed by the PBSSM team (nurse practitioner, physician assistant or physician).
• You may shower the third day after surgery, but do not let water run directly over the wound until directed to do so. Hair can be carefully washed and combed if the wound is minimally wetted.
• DO NOT enter a hot tub, bathtub, pool, ocean or other bodies of water until at least three weeks after surgery. Non-sterile bodies of water may lead to infection.

When can I return to normal activities of daily living? Will I have restrictions?

• It is best not to lift more than five to 10 pounds for the first three weeks after surgery. This weight can be slowly increased to 20 pounds at four to six weeks post-surgery. Do not lift anything beyond 20 pounds until three months post-surgery or unless permitted by the PBSSM team.
• You may be able to drive as early as three to four weeks after surgery, as long as you are not experiencing distracting discomfort, taking pain medications or suffering from seizures. Taking pain medications and driving is dangerous since these drugs can alter the neurological state of wakefulness and consciousness.
• Avoid sitting upright on a hard surface or taking long car rides until two to four weeks after surgery. Avoid activity that presents the potential of falling or physical contact (sports, playing with children, etc.) until your physician gives permission.
• Begin walking as soon as you can after surgery. Walking is an excellent way to prevent blood clots, increase muscle strength and improve cardiovascular health. If walking is difficult due to weakness or balance challenges, your PBSSM team can prescribe physical therapy. Patients with recovery difficulties may require inpatient rehabilitation before discharge from the hospital.

Other Craniotomy Recommendations

Pain medicine can cause constipation. Use stool softeners as needed and eat a high-fiber diet. Avoid straining on the toilet and aim to keep stool malleable.

Since surgery results vary from individual to individual, you may not be able to go home for several days to a week or more after surgery. Depending on the cause of the procedure and presence of brain injury/swelling, several weeks may be required before returning to work. If you are employed at an occupation requiring excessive physical labor or exertion, you may need to take off several months or more. Discuss your work plan with your neurosurgical provider.

Learn More or Schedule an Appointment

To learn more about the craniotomy procedure and how it is performed, use these resources:

• Encyclopedia of Surgery
• Medscape

For questions about your craniotomy or to request information about PBSSM’s advanced spinal, cranial and neurosurgical care, call 215.741.3141 in Pennsylvania, 609.921.9001 in New Jersey, or contact PBSSM online.