Craniectomy: Surgery to Relieve Pressure

Overview

• Definition: A craniectomy is a brain surgery where a part of the skull is removed to relieve pressure on the brain.
• Purpose: To reduce swelling, pressure, or bleeding that can cause brain damage or be life-threatening.
• Procedure: The bone piece removed is not immediately replaced; a follow-up surgery called a cranioplasty restores the skull.
• Types: Decompression craniectomy is a common form used for reducing intracranial pressure.

Conditions Treated

• Swelling and Pressure: Intracranial hypertension.
• Bleeding: Hemorrhages or extra fluid collection.
• Causes: Traumatic brain injury, stroke, blood clots, and hematomas.

Procedure Details

Preparation

• Urgency: Typically an emergency procedure with little time for preparation.
• Pre-surgery Requirements: Include a physical exam, blood tests, and imaging tests (X-ray, MRI, CT scan, PET scan, angiography).
• Medication Adjustments: Possible cessation of blood thinners, and possible prescription of antibiotics or anticonvulsants.

During Surgery

• Anesthesia: Administered; patients may be awake or asleep depending on surgery type.
• Surgical Steps:
  • Shaving and cleaning the head.
  • Making an incision and exposing the scalp.
  • Drilling holes and cutting between them to remove a skull piece.
  • Treating the underlying condition.
  • Covering the exposed skull with mesh material.
  • Closing the incision.
• Duration: Usually 3-5 hours but can vary.

Post-Surgery

• Recovery Location: Intensive Care Unit (ICU).
• Post-Surgery Care: Includes wearing a helmet for skull protection, monitoring vital signs, and preparing for cranioplasty.
• Home Care: Instructions for follow-up care and rest with the head elevated.

Risks and Benefits

Benefits

• Reduces life-threatening complications and potential brain damage.
• Success varies based on health and surgery cause.

Risks

• Potential Complications: Bleeding, hernia, continued pressure, brain damage, infection, seizures, paralysis, mood changes, coma.
• Recovery Challenges: Increased fall risk, balance and coordination issues.

Recovery and Outlook

Recovery Time

• Healing: Skull healing may take 1-2 months; full recovery can take years.
• Activities: Avoid walking unassisted, heavy lifting, driving, manual labor, and exercise until cleared by a surgeon.

Long-Term Care

• Rehabilitation: Extensive rehab and lifelong care may be necessary.

When to Call the Doctor

• Urgent Symptoms: Fever, severe pain, cognitive or mood changes, severe headaches.
• Emergency Symptoms: Seizures, breathing difficulties, stroke signs.

Additional Information

Suboccipital Craniectomy

• Definition: A specific type of craniectomy at the skull base near the neck.

Cleveland Clinic Note

• Emphasizes that craniectomy is a life-saving procedure with potential for full recovery, though side effects and extended rehabilitation are common.

Care at Cleveland Clinic

• Offers comprehensive neurosurgery care for both adults and children.