A craniotomy is an operation on the skull to access the brain. A small area of your child’s head will be shaved, with a cut made on their scalp, a skin flap peeled back, and a piece of bone cut out to access their brain underneath.
In most cases, their bone is replaced securely at the end of operation. However, in some cases the bone is replaced at a later time – your child’s neurosurgeon will discuss this with you if it is required. The operation is performed by a neurosurgeon who specialises in surgery of the brain and spine.
Why is a craniotomy performed?
A craniotomy is needed for various reasons. Your treating doctor will explain to you the exact reason why your child needs the operation. Some reasons include:
- To stop bleeding
- To clean out a brain infection
- To reduce pressure inside the skull
- To remove a brain tumour
- To remove a seizure focus
- To remodel the skull
What to do before the procedure
Before the operation, the neurosurgeon will explain the need and the risks involved in the operation to you and ask for your written consent. Instructions on when your child should stop eating and drinking (called ‘fasting’) will also be provided.
A paediatric anaesthetic specialist will see you before your child’s operation. Some tests may need to be done before it, such as a CT scan, MRI scans and blood tests.
The operation may take four-to-six hours.
Immediately after the operation, your child will go to the recovery room for close observation.
From recovery, your child will be moved either to the ward or to the Paediatric Intensive Care Unit (PICU). You will be contacted before this move.
After the procedure
On their return to the ward or Paediatric Intensive Care Unit, your child will be closely monitored. They may experience nausea and vomiting for a few days, but this varies with each patient.
If your child is sleeping and observations need to be done, they will be woken up. This is necessary to assess their brain function.
Your child will be attached to some machines, including a drip for fluids and medications, and they may also have a tube (called a catheter) inserted into their bladder to drain urine.
They may also have a drain attached to their bandaged head to remove excess fluid from the operation. A doctor or nurse may remove the drain one or two days after the surgery, depending on the output of the drain. Your treating doctor may need to insert a stitch where the drain was removed – a local anaesthetic will be used to reduce pain.
The length of your child’s hospital stay will usually be five-to-seven days. This can vary, depending on why your child needed a craniotomy.
Important things to remember
It is common for your child to have swelling and bruising on their face and their eyes might be closed – this will gradually improve. Swelling usually gets worse for the first 48 to 72 hours and then begins to improve. Depending on the location and size of the craniotomy, this can take a few weeks to resolve.
Post-operation headaches are common and might last for several months.
The skin around the edges of your child’s wound might feel a bit numb until their healing is complete. The numbness might be painful or unpleasant and also feel itchy – this might persist for few months.
The piece of bone cut out during your child’s operation might feel like it moves because of the pressure variance inside their head. It is not dangerous if your child feels a clicking sensation. The piece of bone is secured well and will heal back into place.
Your child’s neurosurgeon will see your child at a follow-up clinic about six to eight weeks after their procedure.
If you have any concerns about your child once they’re home, please phone the Neurosurgery Clinical Nurse Consultant on 3068 1384 or phone 000 in an emergency.
All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.
Information provided and approved by the Westmead Children’s Hospital.