At times, a craniotomy, or temporary removal of a part of the skull, must be performed to treat a hematoma, (intracranial bleeding, or bleeding inside the brain). The cause of such hemorrhage is usually a traumatic head injury from a fall, a vehicular accident or a sports injury. Such incidents are more common in the elderly or in anyone who is taking anticoagulant medication. Because a hematoma may cause unconsciousness and even death, the craniotomy is often a lifesaving operation.
The Craniotomy Procedure
A craniotomy may be performed under general or local anesthesia. The latter is required when the patient's participation is necessary to check for brain function during the procedure. At the beginning of the operation, an incision is made in the scalp to allow access to the treatment site, either with a special saw or a medical drill (for keyhole craniotomies).
The scalp is pulled up and clipped to control bleeding while providing access to the brain. The dura mater, or thick outer membrane covering the brain, is separated from the bone and carefully cut apart to allow any excess fluid that has accumulated to drain. At times, microsurgical instruments may be used under magnification to enable the surgeon to visualize the area more precisely. Once the procedure has been completed, the tissue that has been cut is sutured and normally the bone flap is reattached.
Recovery from a Craniotomy Procedure
The postsurgical craniotomy patient spends some time in intensive care (ICU) until vital signs are stable and the patient is alert. Once out of ICU, the patient will remain hospitalized for several days and oxygen will be administered. Respiratory therapy will be given to make sure the patient's lungs re-expand and that the patient doesn't develop pneumonia.
During recovery in the hospital, the patient will also wear sequential compression devices (SCDs) to prevent the formation of blood clots in the legs and will periodically be administered neurological and cognitive testing to check brain function. While some swelling of the head is expected following the craniotomy procedure, the patient's head is kept elevated to keep such swelling to a minimum. Many patients who have undergone a craniotomy spend several days in a rehabilitation facility after the procedure.