Type of Surgery
Last updated: 11/24/2009
Since the lesion is in the brain, the surgeon uses imaging studies to definitively identify it. Neuroimaging is usually accomplished by the following:
- CT (computed tomography, uses x-rays and injection of an intravenous dye to visualize...
- MRI (magnetic resonance imaging, uses magnetic fields and radio waves to visualize a lesion)
- arteriogram (an x-ray of blood vessels injected with a dye to visualize a tumor or cerebral aneurysm)
Before surgery the patient may be given medication to ease anxiety and to decrease the risk of seizures, swelling, and infection after surgery. Blood thinners (Coumadin, heparin, aspirin) and nonsteroidal anti-inflammatory drugs (ibuprofen, Motrin, Advil, aspirin, Naprosyn, Daypro) have been correlated with an increase in blood clot formation after surgery. These medications must be discontinued at least seven days before the surgery to reverse any blood thinning effects. Additionally, the surgeon will order routine or special laboratory tests as needed. The patient should not eat or drink after midnight the day of surgery. The patient's scalp is shaved in the operating room just before the surgery begins.
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A craniotomy is a surgical operation in which part of the skull, called a bone flap, is removed in order to access the brain. Craniotomies are often a critical operation performed on patients suffering from brain lesions or traumatic brain injury (TBI), and can also allow doctors to surgically implant deep brain stimulators for the treatment of Parkinson's disease, epilepsy and cerebellar tremor. The procedure is also widely used in neuroscience for extracellular recording, brain imaging, and for neurological manipulations such as electrical stimulation and chemical titration.
Human craniotomy is usually performed under general anesthesia but can be also done with the patient awake using a local anaesthetic; the procedure generally does not involve significant discomfort for the patient. In general, a craniotomy will be preceded by an MRI scan which provides a picture of the brain that the surgeon uses to plan the precise location for bone removal and the appropriate angle of access to the relevant brain areas. The amount of skull that needs to be removed depends to a large extent on the type of surgery being performed. Most small holes can heal with no difficulty. When larger parts of the skull must be removed, surgeons will usually try to retain the bone flap and replace it immediately after surgery. It is held in place temporarily with metal plates and rather quickly reintegrates with the intact part of the skull, at which point the metal plates are removed.
Craniotomy is distinguished from craniectomy, in which the skull flap is not replaced, and from trepanation, which is performed voluntarily without medical necessity.
Surgery for removal is generally advised for patients with limited cancer elsewhere in the body and a single brain metastasis.
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