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What is Complex Cranial Surgery?

Complex cranial surgery is the surgical treatment of tumors or lesions in difficult-to-access portions of the brain. It may involve removal of a section of your skull bone called a bone flap. Removing a piece of the skull bone allows your surgeon to access deeper and more difficult parts of your brain while minimizing damage to the brain. The bone flap is replaced at the end of surgery using plates, sutures or wires.

When is Complex Cranial Surgery Indicated?

Your doctor may recommend complex cranial surgery to:

  • Treat brain tumors, hematomas (blood clots), aneurysms and traumatic head injury
  • Remove foreign objects in the brain, treat brain swelling or infection and skull deformity
  • Remove an arteriovenous malformation (AVM) - an abnormal mass of blood vessels
  • Drain a brain abscess (an infected pus-filled pocket)
  • Repair skull fractures
  • Treat and/or repair a tear in the membrane lining the brain (dura mater)
  • Treat epilepsy - a neurological condition involving the brain
  • Implant stimulator devices to treat disorders such as Parkinson's disease or dystonia

Your doctor may recommend the surgery for other reasons as well depending on the need for the procedure.

Pre-surgery Preparation

Before the surgery, your doctor may:

  • Perform a physical exam to make sure you are fit enough to undergo the surgery
  • Evaluate your medical history and recommend blood or other diagnostic tests
  • Instruct you to discontinue all medicines and blood thinners (1 week before surgery)
  • Ask you to stop smoking, tobacco chewing and alcohol consumption
  • Schedule an MRI before your surgery (if image-guided surgery is planned)
  • Instruct you to fast (no food or drink) after midnight, the night before surgery
  • Ask you for a list of medications, foods and any objects you are allergic to

Your doctor may also give you specific instructions based on your medical condition.

How is the Surgery Performed?

Complex cranial surgery involves 6 main steps and takes 5 hours or longer to complete depending on your condition.
Step 1: Preparing the patient

  • You will lie on the operating table and be given general anesthesia to make you sleep
  • Your head is placed in a 3-pin skull fixation device attached to the table to keep your head still throughout the surgery

Step 2: Creating an incision

  • Your surgeon makes an incision on the skin of your head depending on the location of the problem
  • The skin and muscles are lifted off the bone to expose the skull

Step 3: Opening the skull

  • Small burr holes are made in your skull with the help of a medical drill
  • Your skull bone is carefully cut using a special saw
  • The cut bone is lifted and removed and will be replaced after the problem is corrected.

Step 4: Exposing the brain

  • Your surgeon cuts open the protective covering of your brain known as the dura and exposes your brain
  • This allows excess fluid to flow out of your brain so your surgeon has a clear view of the operative area
  • An image-guidance system may be used in the procedure for a better view of your brain

Step 5: Correcting the problem

  • Your surgeon uses a variety of very small medical instruments to carefully remove the tumor or correct the abnormality in your brain.

Step 6: Closing the surgery

  • Your surgeon removes the retractors, if any, and closes the dura with sutures.
  • The bone flap is placed back in its position and secured to the skull with plates or sutures.
  • The muscles, tissue layers,and incision are then sutured closed.
  • Finally, a soft adhesive dressing or sterile bandage is placed over your incision.

Following complex cranial surgery, you may have to stay in the hospital for 3 to 7 days depending on the severity of the problem and extent of the surgery. This may be followed by a rehabilitation process for several days.

Risks Involved in the Surgery

As with any surgery, risks and complications can occur. These can vary depending on the location of the brain that was operated. However, some of the general risks and complications for brain surgery include:

  • Bleeding, blood clots, unstable blood pressure, infection and reactions to anesthesia
  • Stroke or paralysis, seizures, brain swelling, nerve damage,and memory problems
  • CSF (cerebrospinal fluid) leak, loss of mental functions and even coma (very rare)
  • Pneumonia, muscle weakness, and abnormal balance or coordination

Post-surgery Protocol

After the surgery, you will be taken to the recovery room and subsequently to the neuroscience intensive care unit (NSICU) for close monitoring. Once your condition stabilizes, you will be shifted to a regular room and tested with basic commands such as moving your arms, fingers, legs, etc. to assess your brain function.

In the beginning, you will be given liquids to drink and gradually advanced to solid foods. When you are leaving the hospital, your surgeon will advise you on home care protocols and other issues such as:

  • Pain management
  • Restrictions on activities
  • Handling daily activities
  • Incisional care


Your recovery time may vary from 1 to 4 weeks depending on the brain condition treated and your overall general health. It may take you up to 8 weeks to recover fully.

  • American Medical Association
  • American College of Osteopathic Surgeons
  • American Osteopathic Association
  • North American Spine