A craniotomy simply means creating an opening into the skull to expose the brain. The standard way to perform this surgery is to make a burr hole with a drill and then cut the bone flap through the bone with a special saw. Usually, more than one burr hole is used.
The patient’s head is held in a three-pin cranial fixation clamp to prevent head movement during delicate parts of the operation. Dr Steel aims to make the smallest craniotomy necessary. This is known as minimally invasive or keyhole surgery.
It is also important to ensure a good cosmetic result by keeping incisions behind the hairline and away from the face.
Sometimes, patients with complicated lesions close to critical areas are not given a general anaesthetic for surgery. This is called an awake craniotomy.
The scalp and skull are anaesthetised with a local anaesthetic. The patient is first sedated while the brain is exposed, but then woken so they can talk and move while the surgery is being performed. This is helpful when tumours are in or near what we call ‘eloquent’ areas of the brain – important zones where removal would result in an obvious loss of function, such as speech.
Locating the Lesion
Most craniotomies involve navigation assistance to accurately locate a lesion. This helps minimise the size of the cut and the craniotomy.
Often this involves a brain MRI scan and sometimes a CT scan before surgery.
During surgery, Dr Steel uses computer software, a television monitor and infrared cameras to create a complex map of the brain, much like a street directory but in three dimensions. This is called stereotactic navigation.
Minimally invasive or keyhole craniotomy does not necessarily mean the surgery is performed through a small hole. Some operations require a large craniotomy – for instance, when there is a large tumour on the surface of the brain immediately beneath the skull. Such a tumour can only be removed with a large bone flap.
Minimally invasive surgery means using the smallest craniotomy that will allow sufficient exposure without compromising the safety of the surgery.
In the majority of cases, Dr Steel removes little or no hair. It is also important when enclosing the skull not to leave any unsightly defects. For this reason Dr Steel often does a reconstructive cranioplasty using small plates, special titanium discs and bone cement to ensure an even, cosmetic result on the skull.
Craniotomies are not particularly painful. You can expect to wake with a bandage on your head, much like a turban. This generally stays on for 48 hours and helps keep pressure on the scalp to minimise swelling.
The night after surgery is usually spent in intensive care. The nurse will wake you hourly or two-hourly to take your blood pressure, monitor pulse rate, and check your temperature.
The day after surgery involves a CT scan to ensure there is no blood or complication at the operation site before being transferred to a ward.
We encourage you to get out of bed and be mobile on the first and second day after surgery. Patients usually go home after four to five days.