Craniotomy

Overview

A craniotomy is an operation in which a surgeon opens a small window in the skull (the hard bone that protects the brain) to reach the brain underneath. The surgeon carefully lifts out a piece of bone, does the work that is needed, and usually puts the bone back and fixes it in place. The bone heals back over time, like any bone. A craniotomy is not a disease — it is a treatment. It is done for many reasons, such as removing a growth or a blood clot, repairing a bleed or a burst blood vessel, taking a small sample of tissue (a biopsy), or placing a tiny device inside the head.

Craniotomy is a well-established operation carried out in specialist neuroscience centres (hospitals with a dedicated brain and nerve surgery team). It is not something most people will ever need, but it is a routine part of care for a number of brain problems, so surgical teams do it regularly and know how to manage the recovery.

It can affect anyone, at any age. It is more often done in adults, but children sometimes need it too, for example after a head injury or for certain growths. Older adults may have it as well, and the team will weigh up the benefits and risks carefully, taking into account other health conditions and any medicines that thin the blood.

Symptoms

Common symptoms

• Headaches that keep coming back or slowly get worse, especially in the morning or with coughing or bending
• Seizures (fits) — a sudden change in awareness, unusual movements, or a period of confusion
• Weakness, numbness, or clumsiness in an arm or leg, or on one side of the face
• Problems with speech, finding words, or understanding what others say
• Changes in eyesight, such as blurred vision, double vision, or missing part of what you can see
• Feeling sick or being sick, dizziness, or problems with balance and walking
• Memory problems, poor concentration, or changes in personality that family or friends notice
• After surgery: a sore scalp, swelling around the wound, jaw or neck stiffness, tiredness, and short-term changes in memory or concentration

Symptoms in children

• Being unusually sleepy, floppy, or hard to wake
• Being very irritable or crying in a way that is hard to settle
• Vomiting repeatedly, or feeding poorly in babies
• A head that looks larger than expected, or a swelling or soft spot on the head in a baby
• Seizures
• Losing skills they had before, such as walking or talking, or falling behind in development
• After surgery: clinginess, disturbed sleep, and needing more reassurance than usual

Symptoms in older adults

• New confusion or memory problems that come on over days or weeks
• Falls, or unsteadiness that is new
• Weakness on one side, or a change in how the face looks
• Headaches that are new or feel different from usual
• Being more sleepy or less engaged than usual, which family may notice before the person does
• After surgery: extra tiredness, low mood, and a longer time to get back to previous levels of activity

Causes

Main causes

• A growth inside the head (a brain tumour), whether non-cancerous or cancerous
• A collection of blood pressing on the brain, often after a head injury (a haematoma)
• Bleeding inside the head from a burst or weakened blood vessel
• An aneurysm (a balloon-like bulge in a blood vessel) that needs to be repaired or clipped
• A build-up of fluid or pressure inside the head that needs to be relieved or drained
• An infection such as an abscess (a pocket of pus) inside the head
• Taking a sample of brain tissue (a biopsy) to find out what is causing symptoms
• Epilepsy that does not respond to medicines and may be helped by surgery
• Placing a small device, such as a deep brain stimulator or a shunt (a thin tube that drains extra fluid)

Risk factors

• A recent or past head injury
• High blood pressure over a long period
• Smoking
• Taking blood-thinning medicines, which raise the risk of bleeding inside the head
• A bleeding disorder, or a low platelet count
• A family history of brain tumours, aneurysms, or certain inherited conditions
• Increasing age, which makes bleeds after a fall more likely
• Previous brain surgery or radiation treatment to the head

When to see a doctor

See a doctor urgently if:

• A headache that is new, unusual, or getting worse over days or weeks
• Any seizure or fit, even a brief one
• New weakness, numbness, speech trouble, or vision change
• Vomiting with headache, especially in the morning
• Confusion or memory change that comes on over days or weeks
• After surgery: fever, wound redness or leakage, worsening headache, or increasing sleepiness

Book a routine appointment if:

• Questions before planned surgery about what will happen, the risks, and the recovery
• Follow-up appointments after surgery, and any scans or tests your team has arranged
• Ongoing tiredness, low mood, or memory and concentration problems after surgery
• Advice about returning to work, driving, exercise, or travel
• Hair regrowth or how the scar is healing

Diagnosis

A craniotomy is planned after a careful assessment. Your doctor will ask about your symptoms and medical history, examine you — including your nerves, strength, balance, eyes, and memory — and arrange brain scans. The scans show exactly where the problem is and help the surgical team plan the safest way to reach it. You will usually also have a pre-operative assessment (a check-up before surgery) to make sure you are well enough for the anaesthetic.

Tests that may be done

• A CT scan — a quick scan that shows bleeding, swelling, or changes in the bone
• An MRI scan — a detailed picture of the brain and any growth or blood vessel problem
• An angiogram — a scan of the blood vessels in the head, sometimes with a dye
• Blood tests, including clotting tests and blood group, so the team knows how your blood is working
• An EEG (a recording of the brain's electrical activity) if you have had seizures
• Eye and vision checks, and a full nerve and memory examination
• Sometimes a lumbar puncture (a sample of fluid from the lower back), if the team needs to test the fluid around the brain

What to expect at your appointment

You will usually be seen in a clinic where the team explains what the scans show, why surgery is being suggested, and what the alternatives are. You will be asked to sign a consent form, and you can ask as many questions as you like — it is fine to bring someone with you and to write questions down beforehand. Close to the day you may be asked not to eat or drink for a set time, and some hair may be shaved near where the opening will be. The operation is done under a general anaesthetic, so you will be asleep throughout. Afterwards you will wake up in a recovery or intensive care area, where staff will check on you closely for the first day or two.

Treatment

A craniotomy is itself a treatment — it is the operation used to fix or find out about the problem inside the head. Whether it is the right choice depends on what the problem is, where it is, your general health, and what matters to you. Sometimes the team will suggest other approaches first, such as watching and scanning regularly, using medicines, or using focused radiation instead of open surgery. The decision is made together with you, and a second opinion is always reasonable to ask about.

Self-care at home

• Before surgery: keep as active as you safely can, eat well, and follow any instructions about your usual medicines — always check with your team before stopping anything
• Stop smoking if you can, ideally several weeks before surgery; ask for help, as stopping is easier with support
• Keep the wound clean and dry as instructed, and wash your hair only when your team says it is safe
• Take things gently at first: short walks, plenty of rest, and build up slowly over weeks
• Avoid heavy lifting, straining, and contact sports until your team says it is fine
• Keep taking any prescribed medicines exactly as directed, and do not stop them on your own
• Write down questions and symptoms between appointments so you remember to raise them
• Ask for help with shopping, cooking, and childcare in the first few weeks — accepting help is part of recovery

Medical treatments

Around the operation, the team uses medicines to keep you comfortable and safe. These may include pain relief, anti-sickness medicines, medicines to reduce swelling around the brain, medicines to prevent or control seizures, and antibiotics to prevent or treat infection. Some people need steroids to lower pressure inside the head. Blood-thinning medicines may be paused before surgery and restarted afterwards under supervision. Your team will explain what each medicine is for, and your pharmacist can answer questions about how to take them and what side effects to look out for.

When is surgery considered?

Surgery is usually suggested when there is a problem that can be helped by reaching it directly — for example a growth that needs removing or sampling, a blood clot pressing on the brain, a bleeding blood vessel that needs repairing, or pressure that needs relieving. It may be planned in advance or, in an emergency such as a serious head injury, done quickly. Your team will discuss the benefits and risks for your particular situation, including your age, other health conditions, and the position of the problem in the brain. Not everyone needs surgery, and for some people other treatments or careful monitoring are the better choice.

Living with this condition

Recovery after a craniotomy usually takes weeks rather than days. Most people go home within several days but feel very tired for the first few weeks and need to nap. Headaches, a tender scalp, jaw stiffness, and a strange or numb feeling around the scar are common at first, and hair grows back over a few months. You may notice changes in memory, concentration, or word-finding, and these often improve slowly over weeks and months. Your team will advise you about driving, flying, and returning to work, and it is important to follow that advice rather than rushing.

Lifestyle tips

• Build activity back gradually — start with short walks and increase a little each week
• Protect your head: wear a helmet for cycling, and avoid contact sports until cleared
• Keep a simple diary of symptoms, medicines, and questions for your next appointment
• Ask family or friends to help with practical things in the early weeks
• Limit alcohol while you recover and while taking pain relief
• Keep up with follow-up scans and clinic appointments, even when you feel well
• Be patient with your concentration — puzzles, reading, and short tasks can help you gently rebuild stamina

Diet and exercise

Eat regular, balanced meals with plenty of vegetables, fruit, whole grains, and protein to help your body heal, and drink enough water. Gentle movement, such as short walks, is good for your mood, sleep, and circulation, and helps prevent clots. Avoid heavy lifting, straining, and anything that makes you hold your breath for the first few weeks. Your team or a physiotherapist can suggest a safe plan, and some people benefit from physiotherapy, occupational therapy, or speech and language therapy to rebuild strength, daily skills, or communication.

Mental health and emotional wellbeing

It is very common to feel frightened, tearful, or angry around brain surgery, and to feel anxious about scans and results. Some people feel low for a while, or find that their emotions are closer to the surface than before. These feelings are understandable and treatable — talking to your team, a counsellor, or a psychologist can help a great deal, and so can support from others who have been through the same operation. If you ever feel unable to cope or have thoughts of harming yourself, contact your doctor or your local health service straight away, and if you are in immediate danger call your local emergency number. Crisis support is available through your local mental health service — ask your doctor or pharmacist how to reach it.

Prevention

You cannot usually prevent needing a craniotomy, because it depends on what is happening inside the head. What you can do is lower your risk of the problems that lead to it. Protect your head by wearing a helmet when cycling, riding a motorbike, or doing contact sports, and always wear a seat belt. Get high blood pressure checked and treated, do not smoke, and keep alcohol within sensible limits. If you take blood-thinning medicines, have regular reviews and tell any doctor or dentist that you take them. See your doctor promptly about headaches that are new or getting worse, or any seizure, weakness, or vision change, so problems are found early.

Vaccines

There is no vaccine that prevents a craniotomy. Keeping up with routine vaccinations is still sensible, because it lowers the risk of infections around the time of surgery. Your team may advise on specific vaccines before an operation.

Screening programmes

There is no routine screening test for the problems that lead to a craniotomy. If you have a strong family history of brain tumours or aneurysms, or an inherited condition linked to them, talk to your doctor about whether any checks are appropriate for you.

Complications

If left untreated

• Growing pressure inside the head, which can cause worsening headaches, vomiting, and drowsiness
• Continued or repeated bleeding, which can press on the brain and cause weakness or loss of consciousness
• Seizures that are not controlled
• Permanent damage to brain function, such as weakness, speech problems, or memory change
• In some situations, a life-threatening emergency

Long-term outlook

Many people recover well after a craniotomy and return to their usual lives, though it can take months and recovery is rarely a straight line. Some notice lasting changes in memory, concentration, energy, or mood, and these can often be helped with rehabilitation and support. The outlook depends a great deal on the reason for the operation, so ask your team what they expect for you specifically. Whatever your situation, there is support available — you do not have to manage alone.

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