Imagine that a loved one has had an accident or a stroke and suffered a serious head injury. Sometimes doctors say, "The pressure on the brain is too high, so they have to remove a piece of the skull to let the brain in." Hearing something like this makes everyone very scared and shocked, doesn't it? That is what we call a craniectomy in medicine. Although this is a major surgery, it is a very important thing to do to save a life. So don't be afraid, let's talk about this simply, in a way that you can understand.
What exactly is a craniectomy?
Simply put, a craniectomy is a surgical procedure in which a surgeon temporarily removes part of your skull to gain access to your brain. The important thing to note here is that the removed part of the skull is not reattached during the surgery.
Imagine that our brain is inside a skull that is like a tight box. When something like swelling or bleeding occurs in the brain, the pressure inside that box increases greatly. This increased pressure can cause serious damage to the brain, or even be life-threatening. A craniectomy involves removing part of the skull to make room for the swollen brain. This can minimize damage to the brain.
Later, when the swelling in the brain has subsided, the removed piece of skull is reattached in a separate surgery (which we call cranioplasty ) on the same day.
What are the main reasons for performing this type of surgery?
This type of surgery is usually performed in an emergency. Any condition that causes a dangerous increase in intracranial pressure can cause this.
| Reason | A simple explanation |
|---|---|
| Serious Traumatic Injury | Brain swelling due to severe head injury, such as a car accident or fall. |
| Stroke | The brain is damaged and swollen when a blood vessel that supplies blood to the brain bursts or becomes blocked. |
| Blood Clot in the Brain | Increased pressure due to a blood clot in the brain. |
| Hematoma | Blood accumulation in the brain or in the membranes covering the brain. |
How is the surgery done?
Since this is an emergency surgery, the patient doesn't have much time to prepare for it. The doctors quickly perform the necessary tests and refer the patient for surgery.
- Anesthesia: Before the surgery begins, an anesthesiologist will give you painkillers to numb your pain. In most cases, the patient will be put to sleep.
- Preparation: The hair on the part of the head where the surgery will be performed is removed and the area is thoroughly cleaned.
- Making the incision: The surgeon makes an incision in the skin, pushing aside the muscles, and exposing the skull.
- Skull removal: Next, a special large machine (drill) is used to make several holes in the skull, and a section of the skull is carefully removed by cutting through those holes.
- Treatment: After removing the skull, the cause of the pressure on the brain (e.g., removing a blood clot) is treated.
- Temporary closure: The open part of the skull is covered with a special mesh.
- Skin closure: Next, the removed skin and muscles are restored, and the skin is closed using stitches or staples.
Typically, this surgery can take about three to five hours , but the time can vary depending on the cause.
What happens after the surgery?
After surgery, the patient is admitted to the intensive care unit (ICU) , where the medical team constantly monitors the patient's condition and any signs of bleeding or swelling in the brain.
The most important thing is that since part of the skull has been removed, you will need to wear a special protective helmet to prevent any damage to the brain. This is a must-do.
The removed skull fragment is stored safely for future cranioplasty surgery. Sometimes a metal plate or prosthesis may be used instead. It is very important to rest with your head upright while you are in the hospital.
What are the risks and possible complications?
Since this is a major life-saving surgery, there are certain risks and complications that can occur. However, the doctors do their best to minimize these risks.
| Risk/Complication | Description |
|---|---|
| Bleeding | Bleeding in the brain during or after surgery. |
| Infection | Surgical wound or brain infection. |
| Seizure | Seizure-like conditions due to effects on the brain. |
| Brain Damage | Brain function is affected by an existing condition or surgery. |
| Paralysis | Loss of body parts. |
| Changes in behavior or mood | Changes in memory, anger, personality, etc. |
After surgery, there is a greater risk of loss of balance and falls, so it is important to avoid activities such as walking alone until you are fully healed.
How long does it take to heal?
This is a question that many people ask. The recovery time depends on the reason for the surgery and the patient's overall health. A skull fracture can take a month or two to heal. However, a full recovery is a long journey that can take months, sometimes years.
Rehabilitation therapy is essential during this journey. Speech therapy and physiotherapy help you get back to normal life. Also, cranioplasty surgery requires a period of recovery.
When should you call the doctor?
After returning home from the hospital, it is very important to be aware of these symptoms.
| If you have these symptoms, tell your doctor: | |
| - Fever | - Severe headache |
| - Severe pain or swelling at the surgical site | - Changes in consciousness, behavior, or mood |
| These are emergencies! Go to the nearest hospital Emergency Department (ETU) immediately! | |
| - If a seizure occurs | - If you have difficulty breathing |
| - If you show signs of a stroke (e.g., drooping on one side of the face, difficulty speaking, loss of arm sensation) | |
Take-Home Message
- Craniectomy is a very important, major surgery performed to reduce pressure on the brain and save a life.
- This is often done after a sudden head injury or stroke.
- After surgery, it is mandatory to wear a special helmet to protect the brain until the skull is reattached (cranioplasty).
- Recovery is a long journey, and it requires patience, proper rest, and rehabilitation.
- Follow your medical team's instructions exactly. Don't hesitate to talk to them about any questions or concerns you may have.
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