Craniotomy – Craniectomy Essential Brain Surgery

Taking Out Part of Skull in Craniotomy

By Gordon S. Johnson, Jr.

Both a craniotomy or a craniectomy involve taking out a bone flap (a substantial piece of the skull) to give the neurosurgeon access to the inside the brain. In a craniotomy, the bone flap is replaced at the end of the surgery. In a craniectomy, the bone flap is not reinserted when the surgery is completed. The craniectomy (bone flap not replaced) is usually chosen in a severe brain injury in order to allow the brain more room for swelling. A craniectomy can reduce intracranial pressure (ICP).


In a craniotomy or craniectomy, the surgeon removes a piece of the skull – the bone flap – in order to perform surgery inside the brain.

In a craniectomy, the bone flap may be retained until the brain has returned to a normal state of health. Then one more surgery is performed to put the bone flap back.  If the bone flap isn’t reused, plates or artificial bone may be needed for the reconstruction of the skull. In cases where less than total fusion of the skull occurs after the the second surgery, this will cause defects or gaps in the skull.

The amount of the skull needs to be removed in either a craniotomy or a craniectomy depends upon how extensive the neurosurgery being performed.

Problems resulting from a craniotomy or a craniectomy may include seizures.  Thus, anticonvulsants are given for seven days after a craniotomy and a craniectomy. Bacterial meningitis is also a possible complication. Pain is an aspect for craniotomy patients, particularly  scalp pain because of the surgical cut. This pain can be handled through the use of scalp infiltrations, nerve scalp blocks, or morphine.



Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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