Deep Brain Stimulation
Learning About a Craniotomy
You have been told that you or someone you love needs a craniotomy, the surgical opening of the skull. You are likely to have questions about why this is needed. You may also have concerns about what to expect. Your health care team can answer many of your questions. This booklet will also help.
What Is a Craniotomy?
A craniotomy makes a window in the bone covering the brain. This allows a surgeon to reduce pressure beneath the skull. Craniotomy also may be done to remove or repair abnormal structures in the brain.
Concerns About Recovery
You may want to know how a craniotomy will impact your life. Will it change the way you think, act, or move? Learning more about craniotomy can help you gain a greater sense of control. It may also assure you to know that high-tech surgical methods make craniotomy a safer, more effective treatment than ever.
Your Health Care Team
The members of your health care team guide you through your treatment choices. These trained experts will do their best to answer your questions. And they'll give you support over the course of your treatment. Specialists on your team may include the following:
- A neurosurgeon performs the craniotomy and any procedure needed to correct your problem.
- Nurses provide patient care. They may also teach family and friends to assist with your recovery.
- Physical and occupational therapists help with walking, dressing, and other life skills. Speech therapists focus on speech and swallowing problems.
- A case manager or social worker helps guide you through the health care system.
Family and Friends
Family and friends are also key members of your support system. They can be at your side as you find out why a craniotomy is needed. And they can help you throughout your treatment. Many people also gain support from church and community groups.
The Body's Control Center
The brain controls the body. You can move and feel because of the brain. And it is the brain that makes you able to think, m to show emotions, and to make judgments. The brain is protected by the skull, tissue, and fluid.
Functions of the Brain
The brain's right side controls the left side of the body. And the left side of the brain controls the body's right side. Each section of the brain has specific roles. Some skills and traits occur in more than one section. The main parts of the brain and some of their functions are listed below.
Protecting the Brain
Beneath its outer covering of tissue (called the dura), the brain is cushioned and supported by a special fluid. This cerebrospinal fluid fills the space between the dura and brain. Arteries and veins carry blood to and from the brain. Without a fresh supply of blood, brain tissue quickly dies.
Why Is a Craniotomy Needed?
Certain problems keep the brain from working right. Access to the brain is needed to correct these problems. A craniotomy provides this access. The problems discussed below are the most common reasons for performing a craniotomy.
A brain injury can result from a direct blow to the head or even whiplash. It can cause tearing, bleeding, and swelling of the brain. The treatment goal is to stop any bleeding and reduce pressure inside the skull. Blood and damaged tissue may be removed.
A tumor is a mass of abnormal cells. A primary brain tumor starts in the brain. A metastatic brain tumor grows from cells that spread to the brain from some other site in the body. The goal is to remove as much of the tumor as possible. Depending on the tumor, other treatments may also be needed.
An aneurysm is a balloon-like defect in an artery wall. Over time, the defect bulges and weakens. This allows blood to leak out. The leaking blood can damage the brain. The treatment goal is to control damage and prevent future bleeding.
An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels. An AVM prevents normal blood flow through part of the brain. It also increases the risk of bleeding into brain tissue. The treatment goal is to stop blood flow within the AVM and channel it along the normal route.
Diagnosing Your Condition
Your doctor performs certain exams and tests to find the cause of your condition. The results also help your doctor learn the precise location and extent of your problem.
Your Medical Exam
Your doctor finds out how well your nervous system is working by checking your:
- Ability to see, hear, walk, and swallow
- Thinking and memory skills
- Muscle strength, coordination, reflexes, and gait
- Ability to feel and sense of touch
These tests provide images of the brain and the arteries that carry blood to it. For sharper images, contrast mediums may be used with these tests. Risks and complications will be discussed with you.
- CT (computed tomography): This test combines x-rays and computer scans. You lie on a platform that slides into a tube.
- MR1 (magnetic resonance imaging): This test forms images using strong magnets and radio waves. You lie on a table that slides into a tunnel.
- Arteriogram: This test uses x-rays and a special dye to image arteries. If you are allergic to iodine, inform the technologist before your test.
Preparing for Surgery
As your surgery nears, you may wonder about your future health care needs. You may also have questions about how to prepare for your craniotomy. The information below can help.
Arranging for the Future
You may have concerns about your ability to make decisions about treatment in the future. Advance directives can help ease such worries. Recording your wishes on these special legal forms helps ensure that you will get the care you want even if you can no longer make decisions. Your doctor or the hospital can provide the forms that apply in your state.
Before Your Surgery
In many cases, a craniotomy is a planned procedure. If there is time before surgery, you may be told to do the following:
- Weeks ahead of time, you may be asked to donate blood for your surgery. You may also be told to stop taking aspirin and other medications that thin the blood. If you smoke, you should stop now.
- Shortly before the day of your craniotomy, you will have an exam. This ensures that you are healthy enough for surgery. If you take any daily medications, find out if you should still take them the day of surgery.
- At least 8 hours before surgery, or as directed, stop eating and drinking.
The Day of Your Craniotomy
On the day of your craniotomy, arrive at the hospital on time. Once there, you may still have lingering concerns. You're also likely to feel a bit nervous. Your health care team will try to answer all your questions. They will also do all they can to put you at ease.
Just Before Surgery
The health care provider in charge of your anesthesia will talk with you before surgery. You will be given general anesthesia to help you "sleep" through the surgery. At some point, an IV (intravenous) line is placed in your arm. This line can supply medication and fluids as needed. In many cases, part or all of your head is shaved. This is done to decrease the risk of infection.
Note to Family and Friends
You will be shown a nearby room where you can wait during surgery. Craniotomy often takes 3 to 5 hours, or more, to complete. If possible, be sure one person is always in the waiting room to receive any news. The doctor will come talk with you as soon as surgery is over. You'll also be told when you can visit your loved one.
Reaching the Brain
The surgeon makes an incision in your scalp. Then dime-sized burr holes are drilled in the skull. The bone between the holes is cut and lifted away. The surgeon then opens the dura, exposing the brain. The next step will depend on your specific problem (see page 10). In some cases, certain nerves may be stimulated while the response in the brain is monitored. This is done to make sure that normal brain tissue is not disturbed during the surgery.
Risks of Surgery
As with any surgery, craniotomy has certain risks. These include:
- Seizure (jerking movements)
- Loss of memory or confusion
- Swelling or bleeding in the brain
- Blood clots
- Loss of sensation, including vision
- Weakness or paralysis
Correcting Your Problem
Once the brain is reached, what your surgeon does next depends on your problem. But no matter what, every measure is taken to avoid damage to normal tissue.
- Brain Injury - The source of bleeding is controlled and blood is removed. Damaged tissue may also be cleaned away.
- Brain Tumor - As much of the brain tumor as possible is removed.
- Aneurysm - The artery is clipped or sealed at the leak. This prevents more blood from flowing into the brain.
- AVM - The abnormal arteries and veins are clipped. This redirects blood flow to normal vessels and prevents the AVM from leaking blood.
Finishing the Craniotomy
When the goal of the surgery is met, the dura covering the brain is closed. In almost all cases, the skull bone is put back. It may be held in place with wire mesh or screw plates. Sometimes blood or fluid remaining in the brain tissue needs to be removed. In such cases, a drain may be placed through a burr hole for a few days. Most of the time, however, all the burr holes are filled or covered right after surgery. Then the skin incision is closed with stitches or staples.
- Shunts – A shunt is a special type of drain. It is used to drcrease pressure on the brain by removing excess spinal fluid. The fluid is drained from the brain to the abdomen. This is done through a tube that is tunneled under the skin. Once the fulid reaches the abdomen it is absorbed by the body.
- Stereotactic Surgery – Stereotactic surgery improves access to the problems in parts of the brain that are delicate or hard to reach. Stereotactic surgery uses CT or MRI scans to locate the problem and map a precise approach. During this procedure a special frame may be used to hold the head in place.
Recovering in the Hospital
After the craniotomy is completed, the surgeon will talk with your family and friends. You'll wake up in a recovery area. Then you'll be moved to a special unit, often an ICU (Intensive Care Unit), where you can be closely monitored.
Right After Surgery
Upon waking, you may have a headache and body aches. Your nurses can give you medications to ease the pain. Monitors may be used to measure your heart rate or the pressure inside your skull. You may be wearing special leg stockings to help prevent blood clots. And for a short while, you may be placed on a ventilator. This machine helps you breathe.
In Your Hospital Room
You may be moved from the ICU to a hospital room within hours. Or it may take up to two days or longer. Once in your room, you are taught breathing exercises to keep your lungs clear. Your health care team will work to have you eating and walking as soon as possible.
If you are having a hard time doing certain physical activities, therapy may be prescribed. Depending on your needs, therapists can work with you to improve balance, strength, speech, and daily living skills. If you are having problems with strength or movement, your therapist may suggest installing hand rails in hallways or bathrooms at home.
If You Need Other Treatment
After a craniotomy, medications are often prescribed to treat side effects and help you feel better. If you had surgery for a brain tumor, you may also have chemotherapy or radiation.
If medications are prescribed, be sure to tell your doctor or pharmacist about any other medications you are already taking
- Steroids - Steroids reduce brain swelling. Take them as directed. Do not stop taking them without your doctor's OK Steroids can cause blood pressure changes, weight gain, stomach ulcers, increased risk of infection, and mood changes.
- Anticonvulsants - Anticonvulsants help prevent seizures. Always take them as directed. You may have blood tests to make sure you get the right dosage. Call your doctor right away if you have a rash, balance problems, or dizziness.
- Other Medications - You may need other medications to manage symptoms and side effects. Talk with your doctor if you have problems with nausea, stomach acid, or pain.
The goal of chemotherapy is to kill cancer cells. These medications travel through your bloodstream, stopping the life cycle of any cancer cells. As a result, the cancer cells die.
The goal of radiation is to slow or help control tumor growth. It uses painless x-rays to destroy tumor cells. Radiation can be used alone or with other types of treatment.
After Your Hospital Stay
You may be able to go home as soon as you can walk, eat, and drink normally. Back home, family and friends may offer help and support. Accept help when you need it. But it's important to strike a balance. Keep in mind that you're striving to become independent again.
Keep Follow-up Visits
You may have an office visit 7 to 10 days after the craniotomy. At this time, any remaining stitches or staples may be removed. You can expect to meet with your surgeon about every 4 weeks for the first few months. You may also have follow-up imaging tests to ensure your condition is stable.
Start by Walking
Walking is a great way to rebuild your strength. Start out with short, frequent walks. Even if it's just to get a glass of water or to change the TV channel, get up and walk each day. Gradually try walking greater distances, such as to the corner mailbox.
Returning to Daily life
The following hints might help in your recovery:
- Don't overdo it. Increase your level of activity little by little.
- Accept help from those who offer to do household tasks like cooking and yard work.
- Arrange for rides if you're told not to drive for a while. A social worker or discharge planner can help with this.
- Ask your employer about returning to work for fewer hours or working at home.
Coping After Surgery
Accepting what has happened can be hard for you and your loved ones. Your recovery will take time. You may feel more tired than normal for a few months or even a year. Coming to terms with your emotions can help ease the process.
- It’s harder to cope some days than others. So be patient with yourself. If you feel sad or depressed, talk with a member of your health care team. Depression is common and can be treated.
- It’s normal to have fears or feel angry. Counseling or a support group may help you cope with your feelings and the demands or any ongoing treatment. Sharing information with your family can also help.
When to Call the Doctor
Call your surgeon at once if you have any of the following:
- Increased drowsiness
- Ongoing nausea or vomiting
- Extreme headaches
- Increased muscle weakness
- Shortness of breath or pain or swelling in a leg
- Fever of 101 or greater
- Redness or drainage from the incision or an IV site
- Burning during urination