A craniotomy and craniectomy are two types of surgeries that involve removing a flap of bone from your skull to reveal part of your brain.

During a craniotomy, the flap of bone is replaced at the end of the procedure. The hole in your skull is left open after a craniectomy to allow your brain to decompress.

Here, we compare how these two types of surgery are similar and different.

Here’s why you may receive a craniotomy or craniectomy.

Craniotomy purpose

Surgeons perform a craniotomy to access part of your brain. It may be performed as an elective surgery, meaning that it’s planned, or as an emergency surgery.

Some conditions treated with a craniotomy include:

Craniectomy purpose

The main purpose of a craniectomy is to decompress pressure in your brain caused by swelling or the buildup of blood. The main conditions it’s used to treat include:

It may also be used to treat:

Potential risks of a craniotomy and craniectomy are similar. Major risks are rare. They can include:

In a 2020 study, researchers reported a poor outlook rate of 42.7% for craniectomy and 37.5% for craniotomy for 2,370 people treated for severe blunt head injury.

Craniotomy and craniectomy can both be lifesaving procedures.

Craniotomy effectiveness

A craniotomy may be the only treatment option for some conditions like a brain tumor that can’t be accessed with a less invasive procedure. In a South Korean study, researchers found that 25.7% of people among 4,275 treated with a craniotomy to remove a brain tumor died of brain cancer within 2 years.

Craniectomy effectiveness

A craniectomy can be a lifesaving procedure for people who have compression of their brain tissue.

The procedures for craniotomies and craniectomies are similar.

Craniotomy procedure

Here’s a general idea of what happens during a craniotomy:

  1. You’ll receive a general anesthetic through an intravenous (IV) line to put you into a nonfeeling state called anesthesia. You’ll likely have a small part of your scalp shaved.
  2. The surgeon will make an incision in your scalp, usually under your hairline to reveal your skull.
  3. They’ll make a series of holes with a drill called burr holes and then cut through your skull to remove a flap of bone.
  4. They’ll make an incision through the dura matter surrounding your brain to access your brain.
  5. The surgeon will then perform whatever needs to be done on your brain, such as removing a brain tumor.
  6. The piece of your skull will be replaced, and your wounds will be closed with sutures and covered in bandages.

Craniectomy procedure

The procedure for a craniectomy is similar, except the bone flap won’t be replaced right away.

The bone flap is usually placed back several weeks after swelling has improved. The bone flap may be stored in your abdomen or under extreme cold. Sometimes, the hole in your skull will be filled with a synthetic material.

Before an elective craniotomy, the surgeon might tell you to stop taking blood-thinning medications and to quit smoking. They’ll also tell you when you’ll need to stop eating and drinking before your procedure.

A craniectomy is often performed as an emergency procedure, meaning you won’t have time to prepare.

Here’s what you can expect during your recovery.

Craniotomy recovery

Recovery depends on your underlying condition, but you can often expect to stay in the hospital for 5 to 10 days, and you might need 6 to 12 weeks to fully heal.

Craniectomy recovery

Recovery from traumatic brain injury usually occurs the quickest within the first 3 to 6 months. Some people have improvements in brain function for years.

The cost of your procedure can vary widely. For reference, the nonprofit FAIR Health estimates that 80% of procedures in St. Louis to remove a piece of your skull to reduce brain pressure cost less than $10,255, with anesthetics potentially costing another $3,658.

Craniotomy and craniectomy are often covered under insurance programs, including Medicare.

Burr holes and cranioplasty are two other types of surgery used to treat problems with your brain.

Burr hole

Burr holes are small holes that a surgeon makes in your skull. They’re the first step in a craniotomy before removing a flap of bone and are sometimes performed alone to relieve pressure in your brain.


A cranioplasty is the surgical repair of your skull using bone or synthetic tissue. It’s performed after a craniectomy.

Here are some frequently asked questions people have about these two surgeries.

What is the survival rate for a craniectomy vs. craniotomy?

The survival rate for these surgeries depends on the condition they’re used to treat and whether they’re elective or emergency procedures. Emergency surgeries generally have a poorer survival rate.

Do they put the bone back after a craniotomy and craniectomy?

Craniotomy and craniectomy both involve removing a flap of bone from your skull. During a craniotomy, this bone flap is reattached, but during a craniectomy the space is left open.

Craniotomy and craniectomy are two types of surgeries that involve removing a piece of your skull. A craniotomy is often used to fix problems like a brain tumor or aneurysm. A craniectomy is often used after traumatic brain injury to relieve pressure on your brain.