A craniotomy is a neurosurgical procedure that is performed to treat a myriad of afflictions including: subdural hematoma, epidural hematoma, tumor, and other assorted brain lesions. The goal of surgery is to safely relieve pressure on the brain by removing anything that is causing pressure which includes blood clots (hematomas) or tumors.

After observing your recent stereotactic imaging, we will prepare your head for surgery by using place markers with our stereotactic navigation system. This ensures that was are completely accurate and precise with our movements. In order to be completely accurate, we may need to remove some of your hair from your skull. It is at that time once we have the exact markings of your skull, that we remove a small piece. The piece of your skull will be safely stored until it will be reattached with permanent metallic plates and screws.

After we remove the appropriate portion of your skull, we will be using an operating microscope and microsurgical techniques in order to safely and effectively remove the offending material (hematoma, tumor, etc). Once the skull bone is replaced (it may be either immediately after the removal of the material or a few days later, depending on swelling of the brain) and all the layers are sewn (pia, arachnoid, dura) we then use staples to close the skin.

It should be noted that the healing and recovery time can be very variable, being altered by things such as tobacco use. It should be noted that tobacco use can be detrimental on recovery and healing.

If there are any question or concerns you wish to address about the procedure, please contact our medical staff at Princeton Brain, Spine and Sports Medicine.

A week before your surgery is scheduled, do NOT take any NSAIDs (non-steroid anti-inflammatories, e.g. Aleve, Advil, Ibuprofen, Naprosyn.. if you are unsure if your medication is appropriate to take before surgery, please contact our medical staff at Princeton Brain, Spine and Sports Medicine before doing so)

Do not eat or drink any food or beverage after the midnight before your surgery. The only exception is to take your normal medications with a sip of water.

If you are diabetic and require insulin, please consult your Princeton Brain, Spine and Sports Medicine neurosurgical provider about taking this before surgery.

Please prepare to arrive an hour before your scheduled surgery, as if you are late for arrival the surgery may have to be cancelled.

If you have a pre-operative folder and relevant imaging (MRI, CT, X-Ray), please bring them with you to surgery. It should be noted that for a craniotomy, you will be needing a stereotactic image of the brain the day before or morning of your surgery,

As stated above, tobacco use is detrimental on recovery and healing time. It is to be understood that if you partake in tobacco usage, you must abstain two weeks before surgery and two weeks after surgery. Lengthening the halt of tobacco use or quitting all together will not only aid in your recovery for surgery, but will aid in your general health and well-being overall.

My incision site/wound site hurts. What’s going on?

• Pain varies from person to person in regards to their incision. There usually is mild pain at the incision area, though it is more common to experience pain at the base of the neck and your shoulder blades due to the disc space distraction. If there is excessive swelling, drainage, or pus from the incision site please get medical attention immediately. If there is fevers, chills, or nausea please receive medical attention immediately. If you are having trouble breathing, please seek medical attention immediately.

How should I dress my wound? How long until I can dress and bathe normally again?

• Your bandage may be removed the second day after surgery. The steri-strips, staples, and sutures should be left on the incision until you come to your post operative visit so we may exam the wound and remove them for you. This is between one and two weeks after surgery. If you have a drain, you will to track your daily drain output. You will be told how to do this and how to manage the drain properly. Usually the drain can be removed seven days after surgery.
• You may shower the fifth day after surgery if there is no drainage from the incision. If there is drainage, call the office. Excessive showering may irritate the incision. Please also do not make direct contact with the incision, rather let the water naturally run over it. Do not enter a hot tub, bath tub, pool, ocean or any other body of water until at least three weeks after surgery. Entering any non-sterile body of water may cause infection of the incision site.

When can I go about my activities of daily living as normal again? Do I have restrictions?

• Do not lift more than five to ten pounds for the first three weeks after surgery. This can slowly be increased to twenty pounds at around four to six weeks post surgery. Do not lift anything over twenty pounds until after three month post surgery,
• You can drive two weeks after surgery as long as you are not experiencing discomfort when doing nor are taking pain medications. Please note that taking pain medications and driving is illegal as pain medications can alter your neurological state of wakefulness and consciousness, making it dangerous to drive.  It should be noted that you will not be able to  drive if you had seizures.
• Please avoid sitting upright on a hard surface or long care rides until two to four weeks after surgery.
• Please avoid any activity that presents the potential of falling or any physical contact (ex: sports, playing with children) until given permission by your neurosurgical provider.
• Please begin exercising in a safe manner by walking as soon as able after surgery. Walking is a great way to prevent blood clots, to increase muscle strength, and to better your cardiovascular health.

Diet: Pain medications can cause constipation. Using stool softeners and laxatives as well as engaging in a high fiber diet will aid with this. Straining yourself on the toilet is to be avoided, please aim to keep your stool malleable with the recommendations above.

Hospital stay: As surgical procedures can vary from individual to individual, you may be able to go home between the day of surgery to two days post operation.

Returning to work: You can return to work depending on how you feel you are progressing after surgery. Usually, two weeks to recover is sufficient though you may be able to discuss when you feel able to return to work and a medical recommendation with your neurosurgical provider. If you are employed at an occupation that requires excessive physical exertion or labor, you may not be able to return to work for up to one month. This can vary and should be discussed with your neurosurgical provider.

Physical Therapy: Physical therapy is normally referred at your first post surgical visit. As stated above, please avoid twisting and bending your neck with physical therapy. If you begin to feel pain with physical therapy, stop and abstain from doing that specific motion and discuss with your neurosurgical provider the issue at your next post operative visit.