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FAQs: Craniotomy vs. Craniectomy Surgery

 

What is the difference between a craniotomy and craniectomy?

Answer: Both procedures involve removing a portion of the skull, usually to perform surgery on the brain. The difference is that after a craniotomy the bone is replaced and after a craniectomy the bone is not replaced immediately.

What is a cranioplasty and when is it performed?

Answer: A cranioplasty is a surgical procedure to correct a deformity or defect of the skull and it is performed once the neurosurgeon and the family feel that it is clinically indicated.

Why would my child need any of these procedures?

Answer: A craniotomy is performed to gain access to the brain for surgery by removing a portion of the skull. After the surgery, the bone that was removed from the skull is usually replaced using sutures or metal plates. An example of a situation where a surgeon may choose to perform a craniotomy is for removal of a brain tumor. A craniectomy is performed when a portion of the skull is removed but not replaced. Some examples of situations where a surgeon may choose to perform a craniectomy are: to create room for the brain to swell after trauma, to remove the bone due to an infection in the skull or a severely damaged skull with multiple fragments.

A cranioplasty is performed to correct a deformity or defect of the skull. The deformity/defect could be congenital, as a result of trauma or acquired for example after a previous surgery involving the skull. There are a variety of surgical materials and prosthetics used for a cranioplasty. Your child’s neurosurgeon will review what materials will be used for your child’s specific cranioplasty procedure.

What are the benefits vs. risks?

Answer: A full discussion of the benefits and risks of your child’s neurosurgical procedure should be discussed with your child’s neurosurgeon. It is often a good idea to write down any questions you have before your visit so you don’t forget to ask all of your questions. You may also want to bring a pen and paper to take notes during your visit.

Craniectomy:

What is the waiting period until the bone flap is replaced?

Answer: The bone flap is replaced after your child has had adequate time to heal. Your child’s neurosurgeon will decide when your child’s bone flap can be replaced but most often that decision is made when it is safe in order to reduce the risk of infection and/or failure of their cranioplasty. Bone flaps are usually replaced 1 - 3 months after the craniectomy.

What will my child’s head look like during this period?

Answer: Immediately after surgery you may notice that your child is slightly swollen at the craniectomy site. As your child heals and swelling subsides, the craniectomy site will become less swollen and may even appear sunken in.

What are warning signs of a problem that should be brought to the physician’s attention?

Answer: Please do not hesitate to contact your neurosurgeon if you have any concern regarding your child. To reach the Neurosurgery division at Phoenix Children’s Hospital please call (602) 933-0975. We always ask that families seek immediate medical attention for: change in your child’s behavior, repeated vomiting, fever, drainage/redness/swelling at the surgical site, seizure and or pain that is not relieved with oral pain medication.

What safety precautions should I take to keep the head safe?

Answer: Immediately following surgery where a craniotomy is performed, it usually takes at least 6 weeks for the bone to completely heal. You should not allow your child to participate in any activity that may risk a hit to the head or fall since the skull bone may not be adequately healed or following a craniectomy, there to protect the underlying brain. This includes such activities as biking, recreational sports, and or using playground equipment. Many times even after the bone has been repaired, it is not recommended to be involved in contact sports that may risk injury to the head. In instances of a craniectomy, your child also may be sent home from the hospital with a protective helmet. Washing can be done gently, you do not want to vigorously scrub the incision or comb over the incision. Once the incision is well-healed normal washing and hygiene are important.

When can the bone flap be stored and replaced and when are synthetic materials necessary?

Answer: This is usually decided by your child’s neurosurgeon on a case by case basis. However, if there is infection or the bone was damaged, synthetic materials will usually be chosen for the cranioplasty.

If stored, what are the optimal storage methods for the bone flap?

Answer: The bone flap will be stored in a sterile, refrigerated environment, frozen at the hospital until the time that it can be replaced.

If synthetic, what are the different materials used and which are recommended?

Answer: Your child’s neurosurgeon may chose from a variety of titanium mesh, plates, artificial bone matrices, acrylic, other synthetic type materials and/or custom made implants.

Will I have a choice between materials?

Answer: Your child’s neurosurgeon will discuss with you what materials may be best for your child’s unique needs with each of their potential benefits versus risks for final decision to be made prior to surgery.

After a cranioplasty:

Will my child need further surgery as the head grows?

Answer: Not usually. Your child will have several follow-up appointments after surgery to ensure that everything is healing appropriately. It is usually not necessary to replace the cranioplasty materials as your child grows.

Will my child’s head look the same after the surgery as pre-injury?

Answer: Your child’s head should have an appearance very similar to how your child looked pre-injury.Your child will still have a scar at the incision for the cranioplasty site.

How long will my child have to stay in the hospital?

Answer: Your child will be discharged to home once he is able to eat a regular diet, tolerate oral pain medication and has no other medical issues that require hospitalization. Many children go home just a few days after surgery.

What safety measures should be taken post-surgery?

Answer: Your child should not participate in any vigorous physical activity that may risk a hit to the head or fall, for 6-8 weeks after surgery.

Will a shunt be affected by the surgery?

Answer: Not usually. Your neurosurgeon will discuss any concerns regarding your child’s shunt with you prior to surgery.

What danger signs should be reported to the surgeon?

Answer: Please do not hesitate to contact your neurosurgeon if you have a concern or any question regarding your child. To reach the Division of Neurosurgery of the Barrow Neurological Institute at Phoenix Children’s Hospital please call (602) 933-0975. We always ask that families seek immediate medical attention for: a change in your child’s behavior, repeated vomiting, fever, drainage/redness/swelling at the surgical site, seizure and pain that is not relieved with oral pain medication. * Note: These frequently asked questions and answers were peer-reviewed by our partners at BINA Stroke & Brain Injury Assistance.

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