A craniotomy is a neurosurgical procedure used to relieve swelling and pressure on the brain caused by hematoma and trauma. A hematoma is a pool of clotted blood caused by burst blood vessels. There are several types of intracranial hematomas, including subdural and epidural hematomas. The pressure put on the brain caused by the pooling of blood can be life-threatening and should be treated as an emergency.

Baptist Health is nationally recognized for excellence in craniotomy procedures. We offer a full spectrum of neurosurgical care and the latest approaches to craniotomy surgery. Best of all, you’ll appreciate convenient appointment times, locations near you and a personalized focus to meet your needs before, during and after your procedure.

What is a Craniotomy?

A craniotomy involves temporarily removing an area of bone from the skull. When a hematoma is present, a craniotomy allows the pooled blood to be drained. There are numerous types of craniotomy that may be performed depending on the size and location of the hematoma. 

When blood pools on the outside of the blood vessels in the brain, it puts pressure on the brain and causes symptoms including headache, vomiting, confusion, dizziness, weakness, drowsiness and seizures. A craniotomy allows access to the area of the brain where the bleeding occurs in order to:

• Stop the bleeding and relieve pressure
• Relieve the symptoms caused by the pressure

What Can I Expect During the Procedure?

Once a hematoma is diagnosed and a craniotomy is recommended, the area around the surgery site will be shaved, an IV line will be placed in your arm or hand, and, depending on the length of the surgery, a urinary catheter inserted. You may be given a sedative and will receive general anesthesia. The anesthesiologist will monitor your heart rate, blood pressure, breathing and blood oxygen during the surgery.

The location and size of the hematoma will determine the type of craniotomy performed, and the area where the incision is made and the bone removed. Your head will be placed in a device to hold you still during the surgery, and removed once the surgery is complete. Your scalp will be pulled away from the incision site and clipped to control bleeding. A medical drill and special bone saw may then be used to carefully remove a small area of bone without damaging the tissue below.

The bone that is removed will be saved for reinsertion at the end of surgery, or in a follow-up surgery if your doctor recommends leaving the bone off until the swelling has been reduced and drainage is no longer required. The hematoma will then be removed, and the site drained of any excess blood. Drains or pressure monitoring devices may be placed in the skull. The layers of tissue that were opened to expose the hematoma are then stitched back together. If the bone is to be reattached, it is held in place using plates, sutures or wires, and the skin is then closed with sutures or staples.

Recovery

Your recovery process will vary depending upon the type of procedure and the type of anesthesia. The typical hospital stay for a craniotomy procedure is three to seven days, though a longer stay may be required depending on the location of the hematoma and the amount of trauma experienced.

Once you are stable after the surgery, you will be in a recovery room for observation and then moved to the intensive care unit or to your hospital room. Depending upon the type of craniotomy, you may be given medication to decrease brain swelling and oxygen to help with breathing. You will be checked often to test your brain function and strength and medical staff will help you with activities like breathing exercises and special exercises for your arms and legs. Your head may be elevated to prevent swelling, and you will be encouraged to move around.

The urinary catheter may remain for a day or so, until you are able to move around and go to the bathroom on your own. A sequential compression device (SCD) may be put on one of your legs, which will slowly pump air into and out of fitted sleeves while you are in bed to prevent blood clots. You may also be sent to physical therapy to evaluate your strength, and be given exercises to do in the hospital and when you get home.

Estimated Recovery Timeline

Recovery from craniotomy for hematoma can vary greatly from patient to patient. Recovery may last just a few days or require months of intense rehabilitation depending on the area and amount of brain involved. You may be discharged from the hospital to a rehabilitation facility for a short period to help you regain your strength. Once at home, it is important to keep your incision clean and dry. You doctor will give you specific bathing instructions. Your incision and head may ache, especially with deep breathing, coughing and exertion. Take pain relievers as recommended by your doctor, continue your breathing and physical therapy exercises, and avoid respiratory infections and irritants such as tobacco smoke. Avoid heavy lifting for at least a few weeks to prevent strain on the surgical incision.

Craniotomy Possible Risks

Any type of surgery has the risk of complications. The risks from craniotomy surgery include:

• Bleeding
• Blood clots
• Blood pressure instability
• Brain swelling
• Infection
• Pneumonia
• Seizures
• Spinal fluid leakage
• Stroke
• Paralysis
• Coma