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Craniotomy


Medical editor Radec Fric MD
Neurosurgeon
Oslo University Hospital

General

Craniotomy is an operative technique used for meningiomas and brain tumors.

The operation is usually performed under general anesthesia, but in some cases it can be more suitable to keep the patient awake during the procedure.

The skull is opened by excising a free bone flap with a saw. After that, the dura is opened. The subsequent surgical procedure depends on the tumor type and location.

It is often problematic to achieve a satisfactory resection of the tumor and decompression of the surrounding brain tissue if the tumor invades areas with a high degree of functionality. A radical resection if frequently not possible for glioblstoma multiforme.

In the event of growth of remaining tumor tissue or local recurrence, a re-operation should be evaluated depending on the tumor type.

Indication

  • Brain tumor

Goal

  • As radical a resection as possible

Equipment

  • Craniotomy tray, adults
  • Craniofix tray
  • Three point collar
  • High speed drill and saw (craniotomy)
  • Ultrasound aspirator
  • Operation microscope

Preparation

  • Give general anesthesia.
  • Place the patient either in the supine, prone, or park bench position.
  • Fix the head in a three-pin head clamp
  • Give an infection prophylaxis, cortisone and Mannitol® at the beginning of the procedure.

Implementation

  • Make a curved skin incision.
  • Push aside the soft tissue in one layer to uncover the cranium.
  • Cut out a free bone flap with a saw.
  • Insert the operation microscope and open the dura.
  • The tumor is identified in a discolored gyrus centrally in the field. The tumor has a diffuse border towards the normal brain tissue.
  • Biopsy the tumor. Take samples for frozen section and for formalin-fixed examination.
  • All visible tumor tissue should be removed with ultrasound aspirator.
  • Before closure, perform careful hemostasis and rinse the operation field with physiological saline solution until the rinsing water is clear.
  • Stitch the dura along the bone edge.
  • The bone flap should be fixed with three titanium clamps.
  • Make a midline suture for the dura.
  • Close the muscle fascia, subcutis and epidermis in layers.

Follow-up

  • Give steroids for some days after the operation, usually according to a routine, gradual-reduction schedule.
  • Thrombosis prophylaxis with LMWH (low molecular weight heparin) should be given routinely.
  • MRI control should be performed on the first post-operative day.
  • The bandage should normally be removed after a few days.
  • The patient is usually discharged to a local hospital 2-3 days after the operation, depending on the clinical course.
  • Remove staples after approx. 12 days.

Any oncological treatment should begin approximately one month after the operation. The patient should be monitored by an oncology specialist with regular MRI examinations. If there is remaining tumor, resection may be considered in some cases.


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