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To perform certain surgeries in the brain, to repair an aneurysm, remove a tumor or make other repairs, access is needed to reach inside the skull. Neurosurgeons at WakeMed are skilled in what is called a craniotomy. This specialized surgery removes part of the bone from the skull and exposes the brain. These highly trained surgeons use specially designed tools to remove the bone flap to access the surgical site. After surgery, unless there is infection or cancer on the bone, the bone flap is replaced to close the skull.

In some cases, imaging guidance — usually MRI or CT — is used to direct the surgeon to the location inside the brain for surgery.

A craniotomy is done to treat the following conditions or injuries:

  • Brain tumors
  • Aneurysm clipping/repair
  • Blood on the brain or blood clot removal
  • Arteriovenous malformation (AVM) removal
  • Brain abscess repair/drainage
  • Skull fracture repair
  • Stroke/brain injury — pressure/drainage
  • Epilepsy treatment
  • Stimulator device implantation to treat Parkinson's disease or other movement disorders

Learn what to expect from surgery

The surgical site is shaved prior to surgery. Under general anesthesia, the surgeon makes an incision to access the skull. If the procedure is performed using minimally invasive protocols, smaller incisions is made.

The surgeon uses a medical drill to make tiny holes and saw to precisely cut the bone flap and temporarily remove it. The outer covering called the dura mater is separated and cut to reach the brain. Any additional fluid is drained from the site and the corrective surgery is performed. In some cases, the surgeon may use specially designed magnifying instruments to ensure accuracy and precision. A monitor to measure pressures inside the brain may be used during certain procedures. Once the surgery is finished, the bone flap is replaced and attached in its original location and held in place with sutures or wire. In some cases, if the bone flap is infected or was a part of a removed tumor, it will not be reattached.

Most patients are admitted to intensive care for monitoring at first. Normally, patients are hospitalized for three to seven days, based on the type of repair or surgery performed. Some patients may be admitted to WakeMed’s Rehab Hospital for inpatient therapy or will be referred for outpatient therapy once discharged.

It takes about three to four weeks for the incision to heal. During that time, patients should refrain from heavy lifting or high-impact exercise. Some patients keep the site covered with a loose-fitting hat or scarf during this time. The site will be painful and exacerbated with coughing, exertion and quick movements. The surgeon will advise on the best pain regimen to ensure that the patient is comfortable during recovery.