What exactly happens before, during and after a Craniotomy?

Hello, your nervousness is understandable. Have you discussed this with your surgeon? Have alternatives to surgery such as radiation therapy been discussed? Have you or are you getting a second opinion? Surgery is often recommended if the tumor or over a certain size such as 3 cm.
My condition was not a typical meningioma experience because the tumor was large and was causing severe neurological problems. It was considered an emergency and removed three days after finding it.
Typically you will check into the hospital the day before surgery. You will have physical, and neurological testing and blood work. You will be asked your name and date of birth. A lot. You may be asked to shower using a strong antibacterial soap. On day of surgery you will be taken to a pre-op room. There you may be given a sedative and have some antiseptic applied. In the operating room you will be anesthetized. Your head will be placed in a clamping device to hold it steady. The hair at the surgical site will be clipped short. The actual procedure will be particular to your case. I won’t provide detail here. There are many videos available on YouTube if interested. The duration of the procedure usually ranges from a few hours to over 12 hours depending on complexity. My surgery took 4 hours including time to anesthetize. After surgery you will be woken up and taken to a recovery area. You will be given pain medication if you need it. My experience was pretty pain free, just used Tylenol. You will be taken back to your hospital room. You will probably be sleepy for the first 24 hours. You may have to sleep on your back with your head propped up. You may have a drain at the surgical site which will be removed the next day. I had to go to a neurological rehab facility after surgery so my total stay was 19 days. Typically you will be released 3-4 days after surgery. Time to total recovery at home will vary depending on your physical condition before the surgery. I recovered rapidly from the neurological issues and was back to normal activity 5 weeks after surgery. Depending on tumor grade the surgeon may recommend follow-up radiation treatment and regular MRI scans. Sorry for the book length response. Hopefully this helps.

Depending on the location, some scalp is flapped back and a hatch is cut in the skull. The tumor is removed. The hatch is replaced and secured with titanium wires. The skin is sutured back into place. The bone has no nerves so it does not cause pain. The skin can be anesthetized and the sutures can itch as it heals. I had a large tumor removed. Really had minimal post operative pain. I find blood draws more painful than neurosurgery.

I was quoted to expect 2-3 days in neuro ICU and 7-10 days in neuro rehab. I was out of ICU in 1 day and met discharge criteria in rehab by day 3. I was in surgery for 7.5 hours but had one of the best neurosurgeons in L.A. Sadly he may move to Vermont, so if I need surgery again it will be a shlep.

I had tennis ball size tumor with craniotomy. I had very little discomfort after surgery except on my scalp which itches like crazy. Minor headaches that were helped by Tylenol. I didn’t really take anything stronger. I was given steroids so had major munchies for quite some time. I have eaten more tapioca pudding in a few days than want whole life I think. I was moved pretty quickly to rehab floor in the hospital and that was pretty intense and very helpful as I had some left side deficits. My tumor was right frontal lobe which I suppose is the best place to have it if u have to have one since it doesn’t interfere with too much. Or so I am told. I have now done a course of radiation and chemo. No mri for about 3 more weeks or so to give everything a rest from treatment and get amor accurate evaluation since it can appear that the tumor is back if done too early I have had burns on my forehead and head from radiation and tryingno get relief from it. Otherwise it has been relatively easy all things considered. I mean I had like you an alien living in my brain which is disturbing to say the least.

I wanted to add that I had major fatigue from the surgery and recuperation I then had proton beam radiation which added to the fatigue in conjunction with chemo temozolomide if that is spelled right? Tmz

Be kind to yourself. I keep trying to remember that. We have been through a lot!

https://www.ouh.nhs.uk/patient-guide/leaflets/files/11585Pcranial.pdf
https://www.cuh.nhs.uk/patient-information/craniotomy-and-resection-of-brain-tumour-in-adults/
https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Brain-and-spine/Craniotomy-for-brain-tumour-removal-1192-PIL.pdf
After I had my emergency crainiotomy for a 3m meningioma pressing on my optic nerve causing swelling and bleeding, I happened upon British hospitals information and advice papers, attached here. I was sent home after 3 days - timing due to insurance, I was told, had infected hardware that had to be removed due to excruciating pain months later. I am told this infection is not common, but it can happen. I continue to deal with aftereffects and further surgery due to the infected hardware. But, I am not upset. Frankly, these things can happen. Surgeons are humans, and I believe they want the best outcome. I think faith is very important, and a positive attitude helps immensely. At some point, you have to have trust. Blessings and enjoy life now.

I also had a frontal lobe meningioma, not quite tennis ball size but still large enough to cause serious problems. Based on reading other accounts frontal lobe does seem like the least bad area to have a tumor because it’s more accessible than in other areas. Since radiation and chemo were involved did you have a grade 2 or 3 tumor? Were the surgeons able to remove the whole tumor?Mine was grade 2 and completely removed, and the jury is still out regarding radiation treatment. The radiation oncologist was neutral on whether to have radiation treatment. The proposed treatment was intensity modulated radiation, 30 treatments over 6 weeks. I’m worried about long term cognitive effects of that much radiation to the frontal lobe. I’m getting a second opinion on that. Best wishes for a quick and complete recovery.

I was just going to inquire if anyone else had issues with the cranial hardware. A part of my incision wasn’t healing properly and the surgeon commented during the 6 weeks post-op visit that they may have to do a revision surgery to remove a cranial plate. Had an X-ray which showed no signs of infection. A few days later the scab fell out, revealing a hole that went down to the bone. You could see the cranial plate at the bottom of the hole. Naturally this scared the bejeezus out of us and we headed to the ER. The ER in an urban Portland hospital on a Saturday night is an “interesting” experience, worthy of a story in itself. Spent 7 hours there, got an MRI, the doctors determined there was probably no infection and I was sent home. Revision surgery occurred 2 days later. Two cranial plates were removed and the hole was cleaned and stitched up. It was a relative breeze compared to the craniotomy but I still had to spend the night in the hospital. It caused a setback in healing and I had to go on a course of strong antibiotics. Pathology showed no signs of infection so that was fortunate.

Mary: Quite an array of responses. I guess I will add my own. I had my procedure done at the University of Calif. in San Francisco. About 3 weeks before my surgery a Nurse Practitioner called and asked some questions and told me I needed to get blood work done within a 2 week window of my surgery. After my blood work was posted a nurse in the anesthesia department called and asked more questions. After this phone consult with the anesthesia nurse she said, "Ok, I'm going to approve that we go ahead with this surgery." Three days prior to surgery the anesthesiologist called and we had a 25 minute phone consult. Next, I had to travel to San Francisco (90 minute drive if no commute traffic) for another MRI that had to be within 24 hours of the surgery. I was told arrive at the hospital the next morning at 6:30 for my 8 o'clock scheduled surgery and to shower at home beforehand. I was sent to pre-op for more blood work and the IVs put in that the medicine during the operation would be injected into. My anesthesiologist came in and once again asked more questions. Then, my neurosurgeon stopped by and the 3rd year resident who would be "assisting" (though I suspect after reading my reports he handled most of the craniotomy-but it's a teaching hospital so...) spoke with me at length to reassure me that they would not be aggressive in trying to remove the 2.7 meningioma 1/16th of an inch from my optic nerve. If they could scoop it out easily they would but in no way would they try to remove it at the expense of damaging my optic nerve. My conversation with this doctor really made a positive difference. After about 40 minutes it was time to be rolled into the surgery room and I had to say good-bye to my husband. My anesthesiologist and I had talked in pre-op about me getting something, like ativan, to kind of calm my nerves. She said I seemed to be doing fine. That she would give it to me if I wanted but it would prolong the time it would take for me to come out of the anesthesia after the surgery. So I didn't take it. In the future I would. The surgical suite was so cold, so bright, and what seemed for at least a half an hour all this noise of machines being moved around, more IVs inserted in my leg near my ankles, my husband not there, everyone very business like (well it was brain surgery they were getting ready for) and that was the most stressful part of my experience. Like I said, in the future I would take the ativan pre-surgery. The anesthesiologist never said, "Now we're going to put you to sleep." All of a sudden I was just out. My husband and 2 daughters got text messages every 20 minutes or so on how things were going. The surgery lasted just shy of 4 hours. I was told beforehand I would be in the intensive care unit but I was doing so well they put me in the "step down" unit which is a private room with a 1 to 3 nurse to patient ratio. My husband and the daughter without children took 12 hours shifts staying with me in the room with a mini-twin size bed for them. The second day I was walking to the bathroom myself. The 3rd day I went home. They said I didn't need to go to rehab. On discharge day the pharmacist with a PHD in pharmacology personally came to the room to go over all the medicines I would be taking at home. I think I was on keppra for seizures and steroids for inflammation for about 3 weeks to a month. Something like that. I was told to sleep at a 45 degree angle for a period of time, as they had me do while in the hospital. I did that for a week. You'll need one of those angled, wedge pillows. I slept a lot at home but felt fine. They had given me tylenol in the hospital round the clock but at home I think I took it once. I really didn't have any pain. Make sure you already have the stool softener at home before your surgery as it is really important you take this and not strain as that would increase the pressure in your head. My only set back was that my cranial nerve #4 was inflamed from the surgery and I had double vision for 3 1/2 months until it healed from the trauma. OK, Mary. I hope this wasn't T.M.I. I want to reiterate that the hysterectomy I had years ago was FAR worse regarding pain and just feeling horrible for 3 weeks. I was passing out Halloween candy 2 weeks after my craniotomy. My surgery was a year and a half ago when I was 70. Find a reputable hospital and a neurosurgeon you trust and I think you will be fine.