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Craniotomy is a cut that opens the cranium. During this surgical procedure, a section of the skull, called a bone flap, is removed to access the brain underneath. The bone flap is usually replaced after the procedure with tiny plates and screws. A craniotomy may be small or large depending on the problem. It may be performed during surgery for various neurological diseases, injuries, or conditions such as brain tumors, hematomas (blood clots), aneurysms orAVMs, and skull fractures. Other reasons for a craniotomy may include foreign objects (bullets), swelling of the brain, or infection. Depending on the reason for the craniotomy, this surgery requires a hospital stay that ranges from a few days to a few weeks.

What is a craniotomy?

Craniotomy is any bony opening that is cut into the skull. A section of skull, called a blone flap, is removed to access the brain underneath. There are many types of craniotomies, which are named according to the area of skull to be removed (Fig. 1). Typically the bone flap is replaced. If the bone flap is not replaced, the procedure is called a craniectomy.

Craniotomies are also named according to their size and complexity. Small dime-sized craniotomies are called burr holes or keyhole craniotomies. Sometimes stereotactic frames, image-guided computer systems, or endoscopes are used to precisely direct instruments through these small holes. Burr holes or keyhole craniotomies are used for minimally invasive procedures to:

* insert a shunt into the ventricles to drain cerebrospinal fluid (hydrocephalus)

* insert a deep brain stimulator to treat Parkinson Disease

* insert an intracranial pressure (ICP) monitor

* remove a small sample of abnormal tissue (needle biopsy)

* drain a blood clot (stereotactic hematoma aspiration)

* insert an endoscope to remove small tumors and clip aneurysms

Large or complex craniotomies are often called skull base surgery. These craniotomies involve the removal of a portion of the...