Craniotomy/ Craniectomy/ Cranioplasty

Craniotomy defines a procedure whereby surgeons gains access to the cranial cavity to perform a variety of procedures including tumor resection, hematoma evacuation or clipping of a cerebral aneurysm. After incising the skin and with elevation of the scalp, the bone of the skull is exposed. A bur hole is then placed allowing for the creation of a larger cranial window with a pneumatic or electic side cutting drill. At the terminus of the surgery, reimplantation of the bone flap is performed. Typically, rigid fixation is achieved with small MR compatible titanium fasteners (plates) that do not activate metal detectors in airports (Figure 1). Craniotomy is usually described by the area of skull that is exposed i.e. frontal craniotomy, occipito-temporal craniotomy.

Case 1- Figure 1

Craniectomy differs from craniotomy in that the bone is not replaced thus leaving a resultant cranial defect. Craniectomy may be used to in non-emergent circumstances to augment the opening of a craniotomy or as a primary means of exposure. The latter is particularly true when exposing the suboccipital area-behind and below the ear. Reconstruction of the skull-cranioplasty may then be performed with titanium mesh or other artificial products.

Craniectomy is also used in urgent or emergent conditions where there is substantial brain swelling from bleeding, stroke, or infection and the patient's scalp is closed without reimplantation of the bone. After swelling subsides, the bone or other form fitting artificial material is implanted in a procedure called a cranioplasty.