Craniotomy

Craniotomy (from Greek kranion — skull and tome — cut, dissection) is a classical neurosurgical operation involving the temporary opening of the cranial cavity to gain direct access to the brain, meninges, or intracranial blood vessels.

Etiology and pathophysiology

Unlike decompressive craniectomy (where the bone is removed for a prolonged period to relieve pressure), craniotomy necessitates the return of the removed bone flap to its anatomical location at the end of the operation.

The procedure technically begins with an incision of the scalp and the drilling of several small burr holes. Subsequently, the surgeon connects these holes using a special wire saw or pneumatic craniotome, sawing out a bone block (“cap”). The dura mater beneath the bone is incised, providing access to the lesion area.

Clinical significance

In emergency neurotraumatology, this operation is the gold standard for the immediate removal of acute epidural and subdural hematomas that compress the brain. It allows the surgeon to rapidly evacuate dense blood clots, find a ruptured vessel, and securely ligate or cauterize (coagulate) it.

After completion of all intracranial manipulations, the dura mater is hermetically sutured. The removed bone flap is placed back and rigidly fixed to the edges of the defect using miniature titanium plates and screws. This provides immediate brain protection and restores the normal anatomical contour of the patient’s head.