Craniotomy

One option for treatment of a brain tumour is a craniotomy. You may need a craniotomy to remove all, or part of a brain tumour.

What is a craniotomy?

A craniotomy is the most common type of surgery for brain tumours. Whenever possible, your neurosurgeon will try to remove all of your tumour, or as much as is safe to.- not all tumours can be operated on because they may be too close to a sensitive area of the brain, e.g. that controls breathing or sight.

To remove your tumour, your neurosurgeon needs to make a hole in your skull, so they can see into your brain. This requires a small hole through the bone that allows a larger flap of bone to be cut. This operation is called a craniotomy.

What is an awake craniotomy?

A craniotomy is usually performed when you are asleep under general anaesthetic, whereas an awake craniotomy is performed when you are awake.

An awake craniotomy may be performed if the tumour is close to areas of the brain that control important functions. Waking you part way through the operation allows your neurosurgeon to check where these functions are in your brain by asking you to perform certain tasks during the operation, such as reading out loud or moving your arm or leg. This enables them to reduce the risk of affecting these areas.

This treatment option can sound a bit daunting, but if it is thought to be the best one for you, your healthcare team will discuss it with you first, and explain what is done so you can mentally prepare for it.

Before surgery

Before your craniotomy, your neurosurgeon will discuss with you what to expect. Ask as many questions as you would like – there is no such thing as a ‘silly’ question.

You may like to ask about biobanking a frozen sample of your tumour, so you can be a candidate for certain clinical trials in the future and have any relevant genetic (biomarker) tests for your tumour. These tests, which are currently only available for some tumours, can predict how well you might respond to certain treatments. These test may also only be available if the hospital has the necessary facilities. It is worth talking to your neurosurgeon to see if these facilities are available at your hospital.

For more information, see our web pages and fact sheets on Questions to ask, Biomarkers and Biobanking.

Listen to other’s personal experience

In this episode of our podcast ‘Let’s Talk About Brain Tumours’, we talk to Rob, who was diagnosed with a grade 2 glioma, and Carly, with a grade 2 oligodendroglioma, about what it’s like to have a craniotomy.  Both  Rob and Carly had an awake craniotomy while Andy who has a grade 2 meningioma had a craniotomy under a general anaesthetic. Listen as they share their experiences and what helped them prepare for surgery.

What happens during a craniotomy?

• In some cases, patients are first given a drink containing a substance called 5-ALA-around 2-3hours before surgery. This is suitable for some high grade tumours. Sometimes known as the ‘pink drink’, even though it is not pink, this causes the tumour cells in the brain to glow pink under violet light. This helps the surgeon to tell the tumour cells, at the edge of the tumour, apart from the normal cells and therefore remove more of the tumour.
• You will then be given a general anaesthetic to fall asleep
• A small area of your head may be shaved and you may be given an local anaesthetic to a part of your scalp
• An incision (cut) is made in your scalp and a small part of your skull (‘bone flap’) will be removed
• If you are having an awake craniotomy, you will be woken up at this point to allow your neurosurgeon to map where different functions are located in your brain
• As much of the tumour as is safely possible will be removed.
• In an awake craniotomy you may be able to feel a slight bit of movement, but again you should not feel pain as the brain itself cannot feel pain
• If all the tumour is removed, this is known as total resection
• If part of the tumour is removed, this is known as debulking or partial resection.
• A small sample of the tumour (called a biopsy) will be sent to the lab for analysis and diagnosis
• The bone flap will be replaced and the wound closed using stitches or titanium plates and screws – in an awake craniotomy, you may be put back to sleep before this happens. In some parts of the skull the bone may not be replaced, such as the back of the head where there is thick muscle covering the wound.
• You are likely to be given steroids to help with any swelling.

The length of time a craniotomy takes varies according to the part of the brain being operated on. It may take around 4-6 hours, but can be longer too.

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Download more information

Neurosurgery (adults) – (pdf) –

Learn more about neurosurgery including long-term effects and information about when you can return to activities, such as sport or flying.

Neurosurgery (adults) – Clear print (pdf) –

Clear print version of our neurosurgery factsheet, designed to RNIB standards.

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