Craniotomy

Craniotomy is a surgical procedure that involves opening the skull to gain access to the brain. It is one of the key methods in neurosurgery and is used to treat a wide range of brain diseases, injuries, and pathological conditions.

Indications for craniotomy

1. Brain tumors: benign and malignant neoplasms.
2. Traumatic brain injury: intracranial hematomas, depressed skull fractures.
3. Aneurysms and vascular pathologies: rupture or surgical treatment of aneurysms, arteriovenous malformations.
4. Brain abscesses: removal of purulent collections.
5. Epilepsy: elimination of the epileptogenic focus.
6. Hydrocephalus: removal of obstruction or placement of a shunt system.
7. Diagnostic purposes: brain tissue biopsy in cases of uncertain diagnosis.

Types of craniotomy

1. Frontal craniotomy: access to the frontal lobe.
2. Parietal craniotomy: used for procedures in the parietal region.
3. Temporal craniotomy: operations involving the temporal lobe.
4. Occipital craniotomy: access to the occipital lobe or cerebellum.
5. Basal (skull base) craniotomy: access to the base of the skull.
6. Stereotactic craniotomy: targeted access for biopsy or minimally invasive procedures.

Preoperative preparation

1. Diagnostic studies: MRI, CT scan of the brain, cerebral angiography.
2. Laboratory tests: complete blood count, biochemical blood analysis, coagulation profile (assessment of blood clotting).
3. General preoperative preparation.

Surgical procedure

1. Anesthesia. General anesthesia is most commonly used. In some cases (for example, surgery involving speech areas), the patient may remain awake.
2. Opening of the skull. Incision of the skin and soft tissues. Creation of a bone flap (removal or temporary displacement of a portion of the skull bone).
3. Access to the brain. Opening of the dura mater. Performance of the required surgical manipulations (removal of a tumor, hematoma, aneurysm, etc.).
4. Completion of surgery. Restoration of skull integrity (fixation of the bone flap or placement of an implant). Layered closure of tissues.

Postoperative period

1. Intensive care. The patient is transferred to the intensive care unit for close monitoring.
2. Clinical monitoring. Regular assessment of neurological functions and intracranial pressure.
3. Medication therapy. Antibiotics for infection prevention. Analgesics for pain control. Glucocorticosteroids to reduce cerebral edema. Antiepileptic drugs when there is a risk of seizures.
4. Physiotherapy and rehabilitation. Gradual recovery of motor, speech, and cognitive functions.

Rehabilitation

1. Physiotherapy to restore motor function.
2. Speech therapy for speech impairments.
3. Psychological support to help adapt to changes in health status.
4. Regular follow-up imaging: control MRI or CT scan 1–3 months after surgery.
5. Medication support: anticonvulsants and neuroprotective agents.

Craniotomy in Belarus is an essential neurosurgical procedure that allows effective treatment of many brain pathologies. Modern technologies and the experience of Belarusian neurosurgeons make this procedure safe, and timely surgery can significantly improve a patient’s quality of life.