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What’s the Difference Between Craniotomy and Craniectomy?

Two surgical procedures that entail removing a flap of bone from your skull to expose a portion of your brain are called craniotomies and craniectomy.

The bone flap is replaced after a craniotomy treatment. After a craniectomy, the hole in your skull is left open to give your brain time to relax.

Here, we contrast the similarities and differences between these two surgical procedures.


Craniotomy vs. craniectomy purpose

These are the possible reasons for a craniotomy or craniectomy.

Craniotomy purpose

Your brain can be partially accessed by surgeons during a craniotomy. It could be done as an emergency procedure or as an elective procedure, which means that it's planned.

Among the ailments that a craniotomy can address are:
  • brain tumors
  • aneurysms
  • arteriovenous malformations
  • a condition known as subdural empyema
  • bleeding from a blood vessel that is located between your skull and brain (also known as subdural or epidural hematomas)
  • haemorrhage from an intracerebral hematoma, or break in a blood vessel in the brain

Craniectomy purpose

A craniectomy's primary goal is to relieve pressure in the brain that is brought on by edoema or blood clots. It is mostly used to treat the following conditions:
  • middle cerebral artery stroke
  • traumatic brain injury
  • acute subdural hematoma
Additionally, it can be applied to:
  • acute encephalitis
  • cerebral toxoplasmosis
  • subdural empyema, a particular kind of abscess

Potential risks and side effects of craniotomy and craniectomy

The risks associated with a craniectomy and craniotomy are comparable. Large hazards don't happen often. They may consist of:
  • scarring
  • seizures
  • cerebrospinal fluid leak
  • sensitivity to general anaesthetics
  • bleeding
  • infection
  • blood clots
  • permanent brain damage
In a 2020 study, 2,370 patients receiving treatment for severe blunt head injuries had a dismal prognosis rate of 42.7% for craniectomy and 37.5% for craniotomy.


How effective are craniotomy and craniectomy?

Both craniotomy and craniectomy have the potential to save lives.

Craniotomy effectiveness

For certain situations, such as brain tumours that cannot be accessible with a less invasive operation, a craniotomy may be the only available therapeutic option. According to a South Korean study, out of 4,275 patients who had a craniotomy to remove a brain tumour, 25.7% of them passed away from brain cancer within two years following the procedure.

Craniectomy effectiveness

For those who suffer brain tissue compression, a craniectomy may be the only operation that can save their lives.


Craniotomy vs. craniectomy procedures

Both craniotomies and craniectomies follow similar techniques.

Craniotomy procedure

An outline of what often occurs during a craniotomy is as follows:
  • An intravenous (IV) line will be used to administer a general anaesthetic, which will induce anaesthesia—a state in which you are not conscious. Most likely, a tiny portion of your scalp will be shaved.
  • To expose your skull, the surgeon will create an incision in your scalp, typically just below your hairline.
  • They will use a drill known as a "burr hole" to create a series of holes, and then they will cut through your skull to remove a flap of bone.
  • To get to your brain, they will cut a hole in the dura mater that surrounds it.
  • After that, the surgeon will take care of any necessary brain surgery, such as removing a brain tumour.
  • Your wounds will be bandaged and sutured shut, and the missing portion of your skull will be replaced.

Craniectomy procedure

A craniectomy involves a similar process, with the exception that the bone flap is not immediately restored.

Usually, the bone flap is repositioned a few weeks after the edoema has subsided. You can store the bone flap in your abdomen or extremely cold conditions. Occasionally, a synthetic material will be used to fill the hole in your skull.


Craniotomy vs. craniectomy preparation

The surgeon may advise you to give up smoking and blood thinners before an elective craniotomy. Additionally, they will advise you on when to abstain from food and liquids before your treatment.

There won't be much time for preparation because a craniectomy is frequently done as an emergency treatment.


Craniotomy vs. craniectomy recovery

Here are some things to anticipate when you heal.

Craniotomy recovery

Depending on your underlying illness, your recovery may take six to twelve weeks to complete. Generally, you can anticipate being in the hospital for five to ten days.

Craniectomy recovery

After a traumatic brain injury, recovery normally happens most quickly in the first three to six months. For years, some people have experienced improvements in their brain function.


How much does a craniotomy or a craniectomy cost?

Your operation could cost a lot of money. For context, the nonprofit organisation FAIR Health calculates that in St. Louis, 80% of treatments involving the removal of a portion of the skull to lower brain pressure cost less than $10,255, with anaesthetics potentially adding $3,658 to the total.

Medicare and other insurance plans frequently fund craniotomies and craniectomy procedures.


Craniotomy and craniectomy vs. burr hole and cranioplasty

Two more surgical techniques used to treat brain issues are burr holes and cranioplasty.

Burr hole

Small holes created in your skull by a surgeon are called burr holes. They are sometimes carried out on their own to release pressure in the brain. They are the initial stage of a craniotomy, preceding the removal of a bone flap.

Cranioplasty

A cranioplasty is a surgical procedure in which artificial tissue or bone is used to rebuild your skull. It is carried out following a craniectomy.



FAQs

Do they put the bone back after a craniotomy?

A craniotomy is a surgical procedure in which a portion of the skull's bone is removed to reveal the brain. The bone flap is a portion of bone that is removed using specialised equipment. After the brain surgery, the bone flap is temporarily removed and then reinstalled.

What are the disadvantages of craniectomy?

Any surgical treatment carries some general hazards, like anaesthesia responses, infections, and blood clots. Additional dangers unique to craniectomy include: brain inflammation, often known as meningitis.

Can you fully recover from a craniectomy?

After this procedure, many patients recover completely, but adverse effects are possible. After a craniectomy, you may require months or years of rehabilitation and ongoing follow-up treatment, even though the incision site might heal in a matter of weeks.


Takeaway

Two types of operations entail taking out a portion of your skull: craniotomy and craniectomy. A craniotomy is frequently performed to treat conditions such as aneurysms and brain tumours. After a severe brain injury, a craniectomy is frequently performed to relieve pressure on the brain.

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