Craniectomy

A craniectomy is a surgical procedure performed when the portion of the skull removed during brain surgery is not replaced immediately. Reasons for the neurosurgeon to perform a craniectomy include: creating room the brain swelling after traumatic injury, removing infected portions of the skull, or removing portions of the skull where traumatic injury has resulted in multiple fragments. The procedure is always performed as a lifesaving measure.

The Craniectomy Procedure

During a craniectomy, once the patient is anesthetized, the skin on the scalp and the underlying tissues are cut and clipped out of the way. The primary surgical tools employed in the surgery are a drill, used to make holes in the skull, and a saw to cut and remove a bone flap.

After the craniectomy, the bone flap is normally stored in a sterile environment until proper healing has taken place so that the reparative operation can be performed. Usually, bone flaps are replaced 6 weeks to 3 months after a craniectomy. At times, if the damage to the patient's skull is too extensive, or there is infection present, it may be necessary to use synthetic materials, instead of the patient's own bone, to make the repair.

Protecting the Craniectomy Site

It is necessary that the surgical site be carefully protected. In many cases, patients who have had a craniectomy are sent home from the hospital with a protective helmet. For at least 6 weeks, the patient should refrain from any activity that may result in a hit to the head or a fall.

Risks of a Craniectomy

While very often highly effective, brain surgery carries inherent risk. In addition to the risks of any surgical procedure, such as breathing difficulty, excessive bleeding, blood clots and adverse reactions to anesthesia or medication, the major risks of a craniectomy are bleeding in the brain and infection, either of which may lead to further brain damage. It may take at least a year for a patient to fully recover from a craniectomy and rehabilitative treatment may be necessary.

There are several signs that signal the need for urgent medical attention following a craniectomy. These include:

  • Altered behavior, mood or mental ability
  • Repeated vomiting
  • Fever
  • Drainage or swelling at the surgical site
  • Seizural activity

Any headache unrelieved by over-the-counter medication is also cause for concern.

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