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Craniotomy

What is a craniotomy?

A craniotomy is a surgical procedure where a portion of bone is removed from the skull to give surgeons access to your child’s brain. This then allows the surgeons to do further procedures such as:

  • brain biopsies
  • tumour removals
  • epilepsy surgery
  • shunt insertion

If a craniotomy is done but the bone is not replaced, this then becomes known as a craniectomy.

What happens before surgery?

You will meet the neurosurgical team members who will discuss in detail the reasons why a craniotomy or craniectomy is important. you will also need to sign a consent form.

If this is a planned operation then your child will have the opportunity to meet the ward staff and have the process explained to them.

If your child is unwell and needs emergency surgery this will not always be possible.

What happens during the operation?

The operation will be done by a member of our paediatric neurosurgical team in the operating theatre. Your child will have a general anaesthetic so they will be asleep throughout the procedure.

An small cut will be made into the skin just above where the surgeon will do the craniotomy. A section of bone will then be removed to give the surgeon access into the brain tissue or fluid.

If the craniotomy is used for surgical intervention then the bone may be replaced after surgery and the skin above will be stitched back into place. If the bone will not be replaced, and the skin will be closed over the wound without the supporting bone.

What happens after surgery?

Children who have had a craniotomy or craniectomy will recover from the general anaesthetic in the post-anaesthesia care unit (PACU).

They will then be transferred back to the ward or to the high dependency unit (HDU). They will be closely monitored for any signs of complications. These can include:

  • the wound leaking
  • infection
  • increased pressure in the head
  • headaches
  • feeling and being sick

The help to keep you child comfortable. Most children will have a head bandage covering the wound to stop infection and give protection. This should only be removed when the surgeon suggests it.

Children who have had a craniectomy will need to be aware of the area of missing bone to make sure try to stop them causing any damage accidentally.

Some children may have a wound drain in place to help with post-operative drainage, but this can usually be removed after 24 to 48 hours.

How long will we be in hospital for?

Your child can recover from a craniotomy in a few days but the cause or other procedures done as part of the operation may take longer to recover from and lead to further treatments. The neurosurgical team will be able to give guidance about your length of stay.

Will the removed bone be replaced?

Children who have a craniectomy may need their bone replacing at a later date once the swelling has gone down. The neurosurgical team will arrange for scans so that a replacement plate can be made to the exact size and shape needed. This will then be fixed in place by the neurosurgical team under a general anaesthetic.

What are the risks of a craniotomy?

Infection

Because an opening is made through the skin into the brain, infection can get in. This may be a skin infection and can often be treated with a course of antibiotics. Other concerns include deeper infections, however the risk of this is very small. Antibiotics and other precautions are used during surgery to minimise the risk of infection.

Bleeding, bruising and swelling

Some bruising and swelling may appear around your child’s wound site even as far as 2 to 3 days after surgery. This will reduce again as recovery continues and your child goes back to their normal activity.

Pain

Your child may have some pain around the craniotomy site but this is usually easily controlled with pain relief such as paracetamol.

If your child has stronger pain, then they will need stronger pain relief and guidance from the specialist pain team, however once the initial post-operative period has passed this pain will improve.

Cerebrospinal fluid (CSF) leak

The fluid which surrounds the brain and spinal cord is known as cerebrospinal fluid (CSF). Any opening into the skull increases the risk of CSF leaking. Treatment for this is provided by the neurosurgical team.

Brain injury

The risk of this is extremely small, but it is still important to understand. It could be seen in the form of a weakness or paralysis like a stroke and could be temporary or permanent. If something like this were to happen, the neurosurgeon would investigate to find out why it has happened and explain this to you.

Risk to life

Risk to life is usually extremely rare but it is partially dependant on age, weight and general health. The risk is there because this is surgery and also because it usually involves a general anaesthetic.

How do you care for a craniectomy site?

Extra care and precautions need be taken for children with craniectomy sites.

Because there is no bone underneath the skin to protect the brain, damage to the soft tissues can happen much more easily. Children often need to wear padded helmets when moving to reduce the risk of injury.

Small children and those with learning difficulties may have to be reminded not to touch or press their craniectomy site.

Children with craniectomy sites should expect to see a change to the shape or depth of the bone site when they move. Sitting up decreases the pressure in their head which will make the area look ‘sunken’ or “flat”. Laying down for a long period of time will make the area look fuller.

If you see any further changes around the craniectomy site such as boggy areas, or extreme dips or it becoming rigid, then you should seek medical advice immediately.

Frequently asked questions

What about hair washing?

Hair washing will be dependant on the type of stiches used to close the wound.

Dissolvable stitches need to be kept dry for 5 days, so you cannot wash your child’s hair or use hair products during this time. After 5 days you can wash their hair and wound with shampoo only. Do not use conditioner or other hair products until you have had your child’s wound reviewed.

If your child has stitches or clips that need to be removed, you will be given an appointment.

Can my child go on an aeroplane?

There are no reasons a child who has undergone a craniotomy cannot fly, however if a titanium plate has been inserted it is recommended that a cover letter is carried to ensure easy clearance of airport security.

Are there any limitations on sports?

Contact sports (for example rugby and football) should be avoided for a minimum of 12 months. The only sport we absolutely ban is boxing due to the deliberate repetitive head injuries caused. We do however urge caution over scuba diving as well. This is because of the risk of serious harm should there be a problem whilst deep underwater.

Otherwise there are no reasons patients cannot eventually participate in all other sports including swimming and football. Care however is advised to avoid head injury, in particular repetitive head injury.

Does head shape change?

Initially due to the surgery there may be swelling and a head bandage in position so it will be hard to tell. However, after this settles you may notice a change in head shape due to the removal of the bone. This can vary from patient to patient and can change dependant on position and pressure within the head. It can often be quite sunken (due to low pressure) or raised and protruding (due to high pressure). If the bone is left out the Neurosurgical team will discuss with you the plan for replacing the bone. We always consider cosmetic appearance.

What if my child has a head injury?

If your child injures their head, take them to the local A&E department if you have concerns. It would be important to mention to the doctors that your child has had a craniotomy and explain if there is a bit of bone missing from their skull. This will help them assess and treat your child.

Further information

NHS – Epilepsy

Brain and Spine Foundation is a charity helping people affected by brain and spine conditions. It includes information for children and young people.

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Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

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Sheffield
S10 2TH

United Kingdom

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