Brain surgery

Before surgery, the hair on part of the scalp is shaved and the skin is cleaned. The surgeon makes a cut through the scalp to expose the bone (skull). The location of this cut depends on where the problem in the brain is located.

The surgeon uses a high speed saw to cut a portion of the bone (a bone flap) to access the brain.

Sometimes, the surgeon will make a smaller hole and insert a tube with a light and camera on the end. This is called an endoscope. In this case, the surgery will be done with tools placed through the endoscope. An MRI or CT scan and a computerized navigation system can help guide the doctor to the proper place in the brain.

During surgery, your surgeon may:

• Clip off an aneurysm to prevent bleeding
• Remove abnormal blood vessels
• Remove a tumor or a piece of tumor for a biopsy
• Remove abnormal brain tissue
• Drain blood or an infection
• Free a nerve
• Take a sample of brain tissue to help diagnose nervous system diseases
• Put a tube (shunt) in the cavities of your brain to remove excess fluid

The bone flap is usually placed back at the end of the surgery, using small titanium plates to hold it in place. These plates are MRI compatible. This brain surgery is called a craniotomy.

The bone flap may not be put back if your surgery involved a tumor or an infection, or if the brain was swollen. This brain surgery is called a craniectomy. The bone flap may be put back during a future operation.

The time it takes for the surgery depends on the problem being treated.

Brain surgery may be done if you have:

• Brain tumor
• Bleeding (hemorrhage) in the brain
• Blood clots (hematomas) in the brain
• Weaknesses in blood vessels (brain aneurysm repair)
• Abnormal blood vessels in the brain (arteriovenous malformations [AVMs], cavernous malformation)
• Damage to tissues covering the brain (dura)
• Infections in the brain (brain abscesses)
• Severe nerve or face pain (such as trigeminal neuralgia, or tic douloureux)
• Skull fracture
• Pressure in the brain after an injury or stroke
• Epilepsy
• Certain brain diseases (such as Parkinson disease) that may be helped with an implanted electronic device
• Excess cerebrospinal fluid (hydrocephalus)

Risks for anesthesia and surgery in general are:

• Reactions to medicines
• Problems breathing
• Bleeding, blood clots, infection

Possible risks of brain surgery are:

• Problems with speech, memory, muscle weakness, balance, vision, coordination, and other functions. These problems may last a short while or they may not go away.
• Blood clot or bleeding in the brain.
• Seizures.
• Stroke.
• Coma.
• Infection in the brain, wound, or skull.
• Brain swelling.
• The need for more surgery.

Your surgeon will examine you and may order laboratory and imaging tests.

Tell your surgeon or nurse:

• If you could be pregnant
• What medicines you are taking, even medicines, supplements, vitamins, or herbs you bought without a prescription
• If you have been drinking a lot of alcohol
• If you take aspirin or anti-inflammatory medicines such as ibuprofen
• If you have allergies or reactions to medicines or iodine

During the days before the surgery:

• You may be asked to temporarily stop taking aspirin, ibuprofen, warfarin (Coumadin), apixaban (Eliquis), and any other blood thinning medicines.
• Ask your surgeon which medicines you should still take on the day of the surgery.
• Try to stop smoking. Smoking can slow healing after your operation. Ask your doctor for help.
• Your surgeon or nurse may ask you to wash your hair with a special shampoo the night before surgery.

On the day of the surgery:

• You will likely be asked not to drink or eat anything for 8 to 12 hours before the surgery.
• Take the medicines your surgeon told you to take with a small sip of water.
• Arrive at the hospital on time.

After surgery, you will be closely monitored by your health care team to make sure your brain is working properly. The surgeon or nurse may ask you questions, shine a light in your eyes, and ask you to do simple tasks. You may need oxygen for a few days.

The head of your bed will be kept raised to help reduce swelling of your face or head. The swelling is normal after surgery.

Medicines will be given to relieve pain.

You will usually stay in the hospital for 3 to 7 days. You may need physical therapy (rehabilitation).

After you go home, follow any self-care instructions you're given.

How well you do after brain surgery depends on the condition being treated, your general health, which part of the brain is involved, and the specific type of surgery.

Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy

Patterson JT. Neurosurgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 68.

Zada G, Attenello FJ, Pham M, Weiss MH. Surgical planning: an overview. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 18.

Updated by: Luc Jasmin, MD, Ph.D., FRCS (C), FACS, Department of Surgery, Johnson City Medical Center, TN; Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.