Question 1

Craniotomy

Accepted Answer

WHAT IS IT
Craniotomy is a procedure where by a window of skull is removed usually to remove a brain tumour or remove a blood clot or treat a vascular problem such as an aneurysm. The location of the craniotomy depends on where the problem being treated is located.
THE PROCEDURE
Craniotomy is usually performed under general anaesthetic however in certain circumstances it can be performed awake, and this can be useful for removing tumours in critical areas of the brain. An incision is usually made behind the hairline. A Stealth navigation system is often used to help in planning the surgery. This works like a mini ‘GPS’ system in the operating theatre. Burr holes are drilled into the skull and a special drill is used to connect the burr holes and remove the bone. Deep to the bone is the dura. This is a membrane that covers and protects the brain. This has to be opened to perform the surgery. The condition requiring treatment is performed inside the skull. Once the surgery has been completed and any bleeding stopped the dural membrane is normally sutured. Sometimes a dural graft is required to repair the dura. The dural graft can be performed from some of your own tissue such as fascia although sometimes an artificial graft is also used. The bone flap is usually replaced with plates and screws. The scalp and skin are usually sutured and staples used for the skin.
RECOVERY
After surgery you may have some headaches but usually craniotomy is not a particularly painful type of surgery. You may have air in your head after surgery and be placed on oxygen. This air normally resorbs over a number of days.
Following a craniotomy, you will be managed in intensive care and when stable transferred to the ward. You will usually have a CT scan on day 1 postop operatively to check for any complications such as bleeding. You may also require further scans after this.
Your wound staples and normally removed on day 7. It is a good idea to keep the scalp dry for several days. It is also advisable not to pick at the wound to lessen the chance of infection.
You will be reviewed in Neurosurgery + Spine with Prof McDonald at 6 weeks. In some circumstances, you will require closer monitoring. This will be explained on discharge.
RISKS & COMPLICATIONS
Craniotomy is a common and routine procedure performed by neurosurgeons to treat many intracranial conditions. The intracranial condition may have specific risks associated with this. In general terms there is always a small risk of stroke with craniotomies. The risk of this may be around 5%, but it depends on what condition has been treated. After surgery there is a small risk of seizures. Your surgeon will discuss with you the period of no driving. This is typically between 3 and 6 months. You may be placed on antiseizure medication. There are other risks such as post-operative bleeding. If a blood clot forms within the brain this may need to be removed. Blood clots can also form between the skull and the dural membrane (extradural haematoma) or between the dura and the brain (subdural haematoma). If these post-operative blood clots are large, further surgery to remove the haematoma may be necessary. This is also one of the reasons you usually spend the first night after surgery in intensive care. You will stay there until your condition has stabilised. Another serious complication can infection of the brain. If the bone flap becomes infected it may need to be removed and then subsequently replaced after antibiotic treatment, with a titanium plate (titanium cranioplasty). There can also be problems with the spinal fluid leaking out, and this is more common with craniotomies involving the posterior fossa (cerebellar region). Sometimes the scalp can feel numb and there are always risks of wound healing problems. Every operation on the brain also carries the general risks of surgery including anaesthetic risk, medical complications and other complications such as deep vein thrombosis and pulmonary embolism.

Question 2

Brain Tumour Biopsy

Accepted Answer

Details to come.​

Question 3

Shunt

Accepted Answer

Details to come.​

Question 4

Burr Holes

Accepted Answer

Details to come.​

Surgical Treatments

Craniotomy

Brain Tumour Biopsy

Shunt

Burr Holes