A craniotomy requires a hospital stay of 3-7 days, and possibly a rehabilitation facility or unit for several days after your hospital stay. This is all dependent on your condition.
A medical drill may be used to make burr holes in the skull. A special saw may be used to carefully cut the bone. The bone flap will be removed and saved.
The dura mater (the thick outer covering of the brain directly underneath the bone) will be separated from the bone and carefully cut open to expose the brain. Excess fluid will be allowed to flow out of the brain, if needed. Microsurgical instruments, such as a surgical microscope to magnify the area being treated, may be used. This can enable the surgeon a better view of the brain structures and distinguish between abnormal tissue and healthy tissue. Tissue samples may be sent to the lab for testing.
A device, such as a drain or a special type of monitor, may be placed in the brain tissue to measure the pressure inside the skull, or intracranial pressure (ICP). ICP is pressure created by the brain tissue, cerebral spinal fluid (CSF), and blood supply inside the closed skull.
Once the surgery is completed, the surgeon will suture (sew) the layers of tissue together. The bone flap will be reattached using plates, sutures, or wires. If a tumor or an infection is found in the bone, the flap may not be replaced. Also, if decompression (to reduce pressure in the brain) is required, the bone flap may not be replaced. The skin incision (scalp) will be closed with sutures or surgical staples. A sterile bandage/dressing will be applied over the incision.
You may choose to wear a loose turban or hat over the incision. You should not wear a wig until the incision is completely healed (about 3 to 4 weeks after surgery).
Return to Work/Sports:
You may be instructed to avoid lifting heavy items for several weeks in order to prevent strain on your surgical incision.
Do not drive until your physician gives you permission.
Using the sublabial approach, the surgeon through an incision under the upper lip, elevates the lining of the nasal cavity and advances speculum retractors to the sphenoid sinus through the nasal passages. After entering the sella turcica (the area where the pituitary sits in the brain), the tumor is gently removed in the attempt to preserve normal pituitary tissue. A “packing” in inserted in the sphenoid sinus (nasal cavity) with fat harvested from the abdomen and nasal tubes are inserted to assist with nasal breathing. Transsphenoidal hypophysectomy is a well-tolerated surgical procedure, including by older patients who may not be candidates for other treatments. The key benefit is that it does not require craniotomy, which increases patients’ potential risks and hospital stays and recovery times.
The surgery takes about 1-2 hours.