Craniotomy is a specialized surgical procedure involving opening up of the skull or cranium in order to access the brain. It is a major surgery requiring highly specialized skills followed by post surgical care to ensure a safe recovery for the patient. 

Conditions that require craniotomy

There are various conditions that necessitate removal of a portion of the cranium in order to access the brain for treatment of a variety of conditions: 

• Brain tumor
• Aneurysm
• Skull fracture
• Foreign object
• Brain cancer
• Infection
• Cerebral edema or swelling
• Bleeding and blood clots 
• Vascular malformation and arteriovenous malformation.
• Epilepsy

The flap of bone cut away is then replaced after the surgical procedure. There are times when the bone has to be removed and replaced in which case the procedure is known as craniectomy followed by cranioplasty.  

Different types of elective craniotomy

The neurosurgeon determines which type to use depending on the location of the tumor or infection or aneurysm. Some of the common types are: 

• Retrosigmoid is a keyhole incision in the area of the skull behind the ear. 
• Frontal craniotomy in which the front of the skull near the hairline is opened. 
• Suboccipital is carried out at the base of the skull near the neck. 
• Temporal, in which the part of the skull next to the eyes and in front of the ear is opened.
• Orbitozygomatic, in which the skull near the eye socket and the cheek is opened. 
• Parietal,  in which the top middle and upper back of the skull is exposed. 
• Terional refers to the procedure in which the side of the skull behind the temple is exposed.

Treatment of elective craniotomy

A neurosurgeon carries out a detailed pre-operative procedure comprising:

• Physical examination
• MRI, CT Scan, PET Scan or angiography
• Blood tests

The surgeon advises the patient about risks, outcomes, duration, and care required. The patient arrives for the surgery and remains with an empty stomach the night before the surgery. 

Types of elective craniotomy

The operation starts with general anesthesia. Then the surgeon shaves the hair, makes an incision to open the skin, and moves the muscles. This is followed by drilling several holes and cutting between the holes to remove a piece of the skull, followed by the required surgery. The flap is sewn back. 

The second is an awake craniotomy in which the surgeon must check how the patient’s brain functions, especially when a procedure relates to speech or vision. A local anesthetic is used prior to the procedure. 

The procedure for both types of craniotomy could last anywhere from three to five hours. Patients are then transferred to an ICU and stay in the hospital for a week. 

Risk and success rate of elective craniotomy

As with any surgical procedure, there are risks associated with craniotomy, such as: 

• Pain, 
• Hematoma
• Seizures
• Stroke
• Headaches
• Coma
• Hydrocephalus
• Infection

There may be long-term effects such as difficulty in walking, balance maintenance, speech slurring, behavioral changes and scarring. However, given today’s technologies, the success rate is high, with only a 1.2% mortality rate according to sources. 

Why India for elective craniotomy?

India should be your preferred destination for elective craniotomy for several reasons:

• India has some of the best neurosurgeons on call.
• India has some of the finest private hospitals, both large, and small with all facilities for pre, and post-operative care. 
• Costs are far lower across the board, from travel to stay to accommodation, to treatments, and care by expert caregivers at all times. 
• No language or communication gaps. 
• India has a tradition of service and for caring, right from top professionals to people lower down the health care services ladder. People care and it shows. You will like the humane approach. 

A craniotomy is never to be taken lightly. It needs specialists and India is home to some of the best.