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What Is a Craniectomy?

Overview

A craniectomy is a surgery done to remove a part of your skull in order to relieve pressure in that area when your brain swells. A craniectomy is usually performed after a traumatic brain injury. It’s also done to treat conditions that cause your brain to swell or bleed.

This surgery often serves as an emergency life-saving measure. When it’s done to relieve swelling, it’s called a decompressive craniectomy (DC).

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Purpose

What is the purpose of a craniectomy?

A craniectomy decreases intracranial pressure (ICP), intracranial hypertension (ICHT), or heavy bleeding (also called hemorrhaging) inside your skull. If left untreated, pressure or bleeding can compress your brain and push it down onto the brain stem. This can be fatal or cause permanent brain damage.

Purpose

Purpose

A craniectomy decreases intracranial pressure (ICP), intracranial hypertension (ICHT), or heavy bleeding (also called hemorrhaging) inside your skull. If left untreated, pressure or bleeding can compress your brain and push it down onto the brain stem. This can be fatal or cause permanent brain damage.

ICP, ICHT, and brain hemorrhage can result from:

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Procedure

How is this surgery done?

A craniectomy is often done as an emergency procedure when the skull needs to be opened quickly to prevent any complications from swelling, especially after a traumatic head injury or stroke.

Before performing a craniectomy, your doctor will do a series of tests to determine if there’s pressure or bleeding in your head. These tests will also tell your surgeon the right location for the craniectomy.

To do a craniectomy, your surgeon:

  1. Makes a small cut on your scalp where the piece of skull will be removed. The cut is usually made near the area of your head with the most swelling.
  2. Removes any skin or tissue above the area of the skull that will be taken out.
  3. Makes small holes in your skull with a medical-grade drill. This step is called a craniotomy.
  4. Uses a small saw to cut between the holes until an entire piece of skull can then be removed.
  5. Stores the piece of skull in a freezer or in a small pouch on your body so that it can be put back in your skull after you’ve recovered.
  6. Performs any necessary procedures to treat the swelling or bleeding in your skull.
  7. Stitches up the cut on your scalp once the swelling or bleeding is under control.

Recovery

How long does it take to recover from a craniectomy?

The amount of time you spend in the hospital after a craniectomy depends on the severity of the injury or condition that required treatment.

If you’ve had a traumatic brain injury or a stroke, you may need to remain in the hospital for weeks or more so that your healthcare team can monitor your condition. You may also go through rehabilitation if you have trouble eating, speaking, or walking. In some cases, you may need to stay in the hospital for two months or more before you’ve improved enough to return to everyday functions.

While you’re recovering, DON’T do any of the following until your doctor tells you it’s fine:

  • Shower for a few days after surgery.
  • Lift any objects over 5 pounds.
  • Exercise or do manual labor, such as yardwork.
  • Smoke or drink alcohol.
  • Drive a vehicle.

You may not fully recover from a severe brain injury or stroke for years even with extensive rehabilitation and long-term treatment for speech, movement, and cognitive functions. Your recovery often depends on how much damage was done due to swelling or bleeding before your skull was opened or how severe the brain injury was.

As part of your recovery, you’ll need to wear a special helmet that protects the opening in your head from any further injury.

Finally, the surgeon will cover the hole with the removed piece of skull that was stored or a synthetic skull implant. This procedure is called a cranioplasty.

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Risks, side effects, and complications

Are there any possible complications?

Craniectomies have a high chance of success. One study suggests that most people who have this procedure because of a severe traumatic brain injury (STBI) recover despite having to face some long-term complications.

Craniectomies carry some risks, especially because of the severity of injuries that require this procedure to be done. Possible complications include:

  • permanent brain damage
  • pooling of infected fluid in the brain (abscess)
  • brain inflammation (meningitis)
  • bleeding between your brain and scalp (subdural hematoma)
  • brain or spine infection
  • loss of ability to speak
  • partial or full-body paralysis
  • lack of awareness, even when conscious (persistent vegetative state)
  • coma
  • brain death
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Outlook

Outlook

With good long-term treatment and rehabilitation, you may be able to fully recover with almost no complications and continue your daily life.

A craniectomy can save your life after a brain injury or stroke if it’s done quickly enough to prevent damage caused by bleeding or swelling in your brain.

Article resources
  • Decompressive craniectomy and TBI [Video file]. (2016). http://www.nejm.org/do/10.1056/NEJMdo005087/full/ 
  • Ding J, et al. (2014). The influence of decompressive craniectomy on the development of hydrocephalus: A review. DOI: 10.1590/0004-282X20140106
  • Grindlinger GA, et al. (2016). Decompressive craniectomy for severe traumatic brain injury: Clinical study, literature review and meta-analysis. DOI: 10.1186/s40064-016-3251-9
  • Gouello G, et al. (2014). Study of the long-term results of decompressive craniectomy after severe traumatic brain injury based on a series of 60 consecutive cases. DOI: 10.1155/2014/207585
  • Howard JL, et al. (2008). Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury. DOI: 10.1097/TA.0b013e31817c50d4
  • Hutchinson PJ, et al. (2016). Trial of decompressive craniectomy for traumatic intracranial hypertension [Abstract]. DOI: 10.1056/NEJMoa1605215
  • Livesay S, et al. (2014). Evidence-based nursing review of craniectomy care. DOI: 10.1161/STROKEAHA.114.006355
  • Santana-Cabrera L, et al. (2012). Complications of post-injury decompressive craniectomy. DOI: 10.4103/2229-5151.100937
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