Craniotomy

Overview :

There are two basic ways to open the skull:

• a curving incision from behind the hairline, in front of the ear, arching above the eye
• at the nape of the neck around the occipital lobe.

The surgeon marks with a felt tip pen a large square flap on the scalp that covers the surgical area. Following this mark, the surgeon makes an incision into the skin as far as the thin membrane covering the skull bone. Because the scalp is well supplied with blood, the surgeon will have to seal many small arteries. The surgeon then folds back a skin flap to expose the bone.

Using a high speed hand drill or an automatic craniotome, the surgeon makes a circle of holes in the skull, and pushes a soft metal guide under the bone from one hole to the next. A fine wire saw is then moved along the guide channel under the bone between adjacent holes. The surgeon saws through the bone until the bone flap can be removed to expose the brain.

After the surgery for the underlying cause is completed, the piece of skull is replaced and secured with pieces of fine, soft wire. Finally, the surgeon sutures the membrane, muscle, and skin of the scalp.