Cranial Surgery

Craniotomy is surgery involving opening the skull temporarily, allowing an operation to be performed on or around the underlying brain.The main reasons for this surgery are tumours, aneurysms, head injury, and infection.

All surgical procedures are associated with risk.  To exhaustively list all the potential complications is impossible.  In general the overall risk of a major adverse event from cranial surgery is low, but significant.  The specific risk will vary considerably related to the location and type of problem


There are two major risk categories:

  • GENERAL – This is the risk faced by most people undergoing a general anaesthetic.  It includes, but is not limited to, blood clots in the legs (and lung embolism), allergy to drugs, heart attack, lung infection or collapse.  These are all rare but may be very serious if they occur.
  • SPECIFIC – These include but are not limited to, blood clot (this may cause pressure on the brain and require further surgery), swelling (this may cause progressive brain problems in the first hours or days after surgery), seizures (may occur despite anticonvulsants), stroke (due to inadvertent blockage of blood vessel), hydrocephalus (build up of spinal fluid within and around the brain).  Other expected symptoms include headache (rarely severe), numbness/tingling around the wound, jaw ache.

You may be prescribed new drugs around the time of the operation, the most common of which are steroids and anti-convulsants. Steroids (dexamethasone) are used to improve and prevent brain swelling.  They may be used with an anti-ulcer medication such as Pepcidine to protect the stomach.  Anticonvulsants (dilantin) are used to prevent seizures during and after the surgery, often continued post discharge


Almost all cranial operations are done using stereotaxy which is an intraoperative  navigation tool allowing precise anatomical localization.  Usually a preoperative scan is required with fiducials (little things that look like life savers) stuck to the scalp. Usually only a small strip of hair needs to be shaved.  During the operation the head is usually fixed in a clamp with pins pushed into the skull.


A high speed side cutting drill is used to open the skull.  The resultant bone ”window” is replaced at the end of the operation and held with small plates and screws.  For practical purposes the skull is strong and protective immediately afterward.  Occasionally a cranioplasty is used , which is an artificial piece of skull, placed if there is substantial native bone loss.



Most patients will be nursed in an intensive care or high dependency environment for the first twelve hours after surgery. Most patients will have a head dressing, one or more intravenous and intra-arterial lines, and a catheter in the bladder.