Brain surgery treats problems in the brain and the structures around it through an opening (craniotomy) in the skull (cranium).

The hair on part of the scalp is shaved. The scalp is cleansed and prepared for surgery. An incision is made through the scalp. The incision may be made behind the hairline and in front of your ear, at the hairline near your neck, or elsewhere, based on where the problem in your brain is located.

• The scalp is pulled up. A hole is created in the skull. A piece of the skull (a bone flap) is removed. Most of the time, this flap will be placed back after the surgery is over.
• Through this hole, your surgeon may clip off an aneurysm to cut off the blood flow, biopsy or remove a tumor, remove an abnormal part of your brain, or drain blood or an infection.
• Your surgeon may use a special microscope to perform the procedure. Monitors to check pressure may also be used.
• If possible, the surgeon will make a smaller hole and insert a tube with a light and camera on the end (endoscope). The surgery will be done with tools placed through the endoscope.

The surgeon may use computers to help find the exact spot that needs to be treated (MRI or CT scans).

The bone is usually replaced and secured in place using small metal plates, sutures, or wires. The bone flap may not be put back if your surgery involved a tumor or an infection, or if the brain was swollen. (This is called a craniectomy.)

The time it takes for the surgery varies based on the type of problem that is being treated.

Brain surgery may be needed to treat or remove:

• Brain tumors
• Bleeding (hemorrhage) or blood clots (hematomas) from injuries (subdural hematoma or epidural hematomas)
• Weaknesses in blood vessels (cerebral aneurysms) See also: Brain aneurysm repair
• Abnormal blood vessels (arteriovenous malformations; AVM)
• Damage to tissues covering the brain (dura)
• Infections in the brain (brain abscesses)
• Severe nerve or facial pain (such as trigeminal neuralgia or tic douloureux)
• Skull fractures
• Pressure in the brain after an injury or stroke
• Some forms of seizure disorders (epilepsy)
• Certain brain diseases (such as Parkinson’s disease) that may be helped with an implanted electronic device

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

Possible risks of brain surgery are:

• Surgery on any one area may cause 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, in the wound, or in the skull
• Brain swelling

You will have a thorough physical exam. Your doctor may perform many laboratory and x-ray tests.

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs, supplements, vitamins, or herbs you bought without a prescription
• If you have been drinking a lot of alcohol

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always try to stop smoking. Ask your doctor for help.
• Your doctor 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 usually be asked not to drink or eat anything for 8 to 12 hours before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After surgery, you'll be closely watched in the intensive care unit (ICU). When you are stable, you will then go to a room where a doctor or nurse will monitor you closely to make sure your brain functions are working well. They 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 higher to help reduce swelling of your face or head, which is normal.

You may have pain after surgery while you are in the hospital. Your doctor or nurse will give you medicines to help with this.

You will usually stay in the hospital for 3 to 7 days. You may need physical therapy (rehabilitation) while you are in the hospital or after you leave the hospital.

The results depend on the disease or problem being treated, your general health, which part of the brain is involved, what procedure is being done, and the surgical techniques used.

Ortiz-Cardona J, Bendo AA. Perioperative pain management in the neurosurgical patient. Anesthesiol Clin. 2007 Sep 01;25(3):655-74, xi

Patterson JT, Hanbali F, Franklin RL, Nauta HJW. Neurosurgey. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 72.