Minimally Invasive Craniotomy

Some problems in the brain, such as tumors and blood clots, can be deep below the surface. Normal brain surgery to remove them can damage the healthy brain between the surface and the problem. A minimally invasive craniotomy allows treatment of areas deep inside the brain, resulting in less damage to the healthy brain in between, smaller skin and bone openings and shorter hospital stays. This procedure is best for problems that are small to medium in size, are deep below the surface of the brain and cannot be reached easily through another route.

After the patient is asleep, a navigation system (similar to GPS) is mapped onto the patient’s face and head. It is used to plan a path through the brain to the disease being treated. Before surgery, special imaging studies will be done to look at brain anatomy, fiber pathways inside the brain and/or blood vessels to pick the best, safest pathway to the problem area. Small skin and bone openings are made, and a narrow tube is used to dilate the healthy brain between the surface and the disease. The surgery is performed through this tube using special magnifying cameras and equipment. At the end of the surgery, the tube is gently removed, allowing the healthy brain to return to its normal position. The small bone opening is reattached with metal plates and the skin is closed with stitches and staples.

Bleeding and infection are risks of any surgery, although they are very low in this procedure. There is a chance that the brain around the disease or the area of the brain that is passed through could be damaged, which could cause new neurologic problems. Additionally, there is a chance that the entire disease cannot be removed with surgery and may need further treatment.

You should be off of any blood thinning medication for this surgery.  Smoking and alcohol use should be stopped before surgery. You do not need to shave your head for surgery! Minimal hair will be removed to perform this procedure. You may need appointments for medical clearance or to get special imaging studies before your surgery. 

In most cases, the patient will spend the first night in the neurosurgical intensive care unit to watch for any neurologic changes and to keep blood pressure well controlled. Most patients can be discharged to home one to two days after surgery, although that depends on the part of the brain where the surgery took place and what problems the patient was having before the surgery. The skin is usually closed with staples, which will be removed about two weeks after surgery. Patients can wash their hair two days after surgery, in most cases. 

Avoid alcohol and recreational drugs and do not smoke. Smoking can delay healing and contribute to postoperative infection.

Your surgeon will give you specific instructions about activity and restrictions at home.

We recommend that patients do regular but light activity for the first few weeks after returning home. Heavy lifting and exercise should be avoided, but frequent walks are encouraged. There may be some pain or discomfort around the surgical area for a few weeks after surgery, but this is usually well controlled with the pain medicine prescribed at your discharge.