Dr. Victoria E. Clark, MD, PhD

Craniotomy and craniectomy are surgical procedures used to access the brain and treat tumors, intracranial pressure, or other conditions. These surgeries are performed by creating holes in the skull, or cranium, to expose the brain. The opening in the skull can be immediately replaced (craniotomy), or it can be replaced during a later procedure (craniectomy). The following procedures use craniotomy or craniectomy:

• Brain biopsy, which is done by guiding a needle through the opening in the skull to the targeted area of the brain. This procedure may be performed through an open or minimally invasive approach. The minimally invasive approach, called stereotactic brain biopsy, uses a computer to guide the needle.
• Brain tumor resection, which may be performed following a biopsy with image guidance. Depending on the size and location of the tumor, resection will require 2-5 hours.
• Cerebrospinal fluid (CSF) leak repair, particularly for leaks that continue for a long period of time after a surgery. CSF leaks that are left untreated can lead to complications such as meningitis, an inflammation of the outer layers (meninges) of the brain.
• Decompression, often following a stroke or injury. Decompressive craniotomy or craniectomy temporarily removes a flap from the skull to give the brain more room for swelling, which provides pressure relief.
• Hematoma evacuation, which can also relieve pressure on the brain. A hematoma is a swelling of clotted blood. It can occur between the skull and the outer covering of the brain, or dura (epidural), between the dura and the brain (subdural), and within the brain (intracerebral). Craniotomy or craniectomy may be used to access and remove the hematoma.