A craniectomy is a type of brain surgery in which doctors remove a section of a person's skull. Doctors do this surgery to ease pressure on the brain caused by swelling or bleeding. You might hear your care team call this procedure "decompression craniectomy." Your doctor will leave the skull open until the pressure goes down. Then, they will close the opening in the skull. That is called "cranioplasty."
A craniectomy is done only when a person is in critical condition. The surgery can lessen the risk of brain damage after an injury or stroke.
What Causes Pressure on the Brain?
The brain is a delicate organ that has multiple layers of protection. The most obvious layer is your skull, whose bones protect your brain against injuries. Inside the skull, the brain is wrapped in tissue layers called the meninges. There is fluid in the meninges called cerebrospinal fluid, which adds a final layer of protection.
If the brain swells or the fluid builds up inside your skull, intracranial pressure also increases. Pressure can injure brain tissue and cause lasting brain damage. There are several causes for increased pressure on the brain, including:
- Too much cerebrospinal fluid
- Bleeding or blood pooling in the brain
- Brain or head injury that causes swelling
- Brain tumor
- Brain infections such as encephalitis or meningitis
- High blood pressure
- Stroke
- Aneurysm
There are several different treatment options for the pressure on the brain, including medication to reduce swelling or a procedure to drain the fluid. In some cases, a person needs a craniectomy to release the pressure and reduce the risk of brain damage.
What Are the Symptoms of Intracranial Pressure?
Intracranial pressure is a serious issue that needs immediate medical help. Some symptoms can warn you about pressure on your brain. Many of the symptoms can be mistaken for those of other health issues. Call your doctor right away if you have more than one of these symptoms or if the symptoms get worse instead of better:
Why Is a Craniectomy Performed?
When the pressure inside your skull builds and doctors can't reduce it any other way (such as medicines or draining fluid), you may get a craniectomy. Sugeons do this procedure to reduce the swelling or bleeding in your brain and lower the risk of brain damage caused by dangerous pressure on your brain tissue.
How Is a Craniectomy Done?
Before deciding to do a craniectomy, doctors will order an MRI or other imaging to get an idea of what's happening inside the skull. They will want to know where any injuries or blood clots are located. This helps them target the areas with the highest pressure when they operate.
You will be under general anesthesia during the surgery. Doctors need to carefully cut the skin to expose the bone of your skull. Using special tools, they make holes in the skull around the section of bone they will remove. They use a bone saw to cut from hole to hole, then lift the segment of the skull away.
Once the doctors can see the brain, they may remove blood clots or clear any excess fluid. They don't replace the bone right away. Instead, they will give you a special helmet to protect your brain. The hole in the skull will stay open until the swelling and pressure have gone down.
This procedure is different from another surgery called a craniotomy. For a craniotomy, doctors open the skull the same way, but they replace the bone when they have finished operating.
What Is Craniectomy Recovery Like?
After a craniectomy, you will need to stay in the hospital. Other injuries or prior illnesses will have an effect on recovery time. The length of time you will need to stay in the hospital will depend on your overall health.
Replacing the bone. Doctors decide when to close the opening in the skull based on how long it takes for brain swelling to go down. This process can take several months. Doctors preserve the bone removed in the initial operation, and they try to use it to close the hole. If they can't use the original bone, doctors will use artificial bone to close the skull.
Outlook after surgery. There may already have been some brain damage before the craniectomy is performed. Many people will need rehabilitation services for months or years after getting a craniectomy. Physical, occupational, and speech therapy can help them recover from brain injuries.
If you or someone you know needs a craniectomy, you can talk to the medical team about the next steps for treatment. Recovering from brain surgery can be complicated, so it's important to follow your doctor's instructions.
Craniectomy Complications
Your doctor will suggest a craniectomy only if the benefits are greater than the risks. Complications you might have include:
- Brain damage
- Bleeding in and around the brain
- Infection
- Seizure
- Heart attack
- Coma
Some risks may even cause death. And there's a chance the craniectomy might not relieve enough pressure on your brain. It's important to talk to your doctor to find out what risks might apply to you.
Craniectomy FAQs
Can you live a normal life after a craniectomy?
Yes. A lot of people make a full recovery after a craniectomy surgery. Some may survive, but with some side effects. Your overall health and the reason you're having the operation will determine your survival rate.
How long does a craniotomy take?
The total time depends on why you are getting the surgery. But a craniotomy – in which the surgeon cuts open some of the skull for treatment of brain tumors or other procedures and then replaces the bone – normally takes three to five hours.
How long do you stay in the hospital after a craniectomy?
Most people who have a craniectomy have to stay in the hospital for a few days to two weeks. You might have to go to rehab to retain strength and mobility after your hospital stay.
