Craniotomy - Neurosurgical Associates of San Antonio

The Operation
Surgery for most cerebral aneurysms takes place deep inside the brain, between its lobes and near vital arteries and nerves.

After a general anesthetic has been given, the patient is positioned according to the area of the brain that must be reached. Usually, the craniotomy is performed with the patient lying on his or her back. The hair over the incision area is then clipped and shaved.

The patient’s blood pressure may be lowered with medication to allow the operation to proceed with less risk of re-bleeding.

After a general anesthetic has been given, the patient is positioned according to the area of the brain that must be reached. Usually, the operation is performed with the patient lying on his or her back. The hair over the incision area is then clipped and shaved.

The patient’s blood pressure may be lowered with medication to allow the operation to proceed with less risk of re-bleeding.

Incision

A curved incision is made in the scalp over the appropriate location. The scalp flap is then laid back to expose the skull.

Craniotomy

Next, a small burr hole is drilled in the skull with a power drill. A surgical saw is used to connect the holes and create a “window” in the skull through which surgery will take place. The removed bone piece is kept sterile for replacement at the end of the operation.

Exposure of the brain

The exposed dura is cut with a scalpel or scissors and is laid back to uncover the brain. A surgical microscope is used as the procedure is continued.

Identifying and clipping the aneurysm

The brain’s lobes are gently retracted (pulled back) until the location of the aneurysm is reached, using the surgical microscope and microsurgical instruments.

The tissue-paper-thin aneurysm is carefully freed from the scar tissue surrounding it, and its junction with the brain’s blood vessels is identified. One of various kinds of clips is placed across the base of the aneurysm and is adjusted until its position is accurate. This allows the aneurysm to collapse as shown in, but spares the essential blood vessels around it.

At times the aneurysm will rupture again while surgery is taking place. The surgeon then carefully tries to control the hemorrhage while continuing the delicate clipping procedure.

Replacement of bone

After the dura has been stitched closed, the piece of bone is replaced, using wires made of surgical steel (which will remain in place permanently). An intracranial pressure (ICP) monitoring device may then be implanted.

Incision closure

The craniotomy is completed when the incision is closed in several layers. Unless dissolving suture material is used, the skin sutures (stitches or staples) will have to be removed after the incision has healed.