A craniotomy is a major brain surgery in which a bone flap from the skull is temporarily removed to have an access to the brain. This procedure is mainly performed in patients who suffer from traumatic brain injuries or brain lesions. It is a highly critical procedure and a patient may take months to recover from it. This surgery is also conducted prior to the placement of deep brain stimulators, which is often recommended to patients suffering from epilepsy and Parkinson’s disease. This procedure has a wide range of other applications as well such as brain imaging and electrical stimulation.

Craniotomy in Singapore

A craniotomy is a highly sensitive procedure that is performed in some of the top neurosurgery hospitals in Singapore. Because of the sensitivity of the procedure and the risks involved, this surgery should only be conducted by highly experienced and skilled surgeons. The top neurosurgeons in Singapore are educated from some of the most prestigious medical universities in the world. They hold several years of experience in conducting all types of brain surgeries and have so far treated thousands of patients from around the world.

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Craniotomy surgery is one of the most common types of brain surgery conducted to treat a brain tumor. It mainly aims at removing a lesion, tumor, or a blood clot in the brain by opening a flap above the brain to access the targeted area. This flap is removed on a temporary basis and again put in place when the surgery is done. Around 90 percent of the cases of brain tumors are diagnosed in adults aged between 55 and 65. Among children, a brain tumor is diagnosed within an age range of 3 to 12 years.

Craniotomy procedures are conducted with the help of magnetic resonance imaging (MRI) scans to reach the location precisely in the brain that requires treatment. A three-dimensional image for the same is achieved of the brain in conjunction with localizing frames and computers to view a tumor properly. A clear distinction is made between abnormal or tumor tissue and normal healthy tissue and to access the exact location of the abnormal tissue.

Who requires a craniotomy?

In a minimally invasive craniotomy procedure, a burr hole or a keyhole may be created to access the brain to fulfill the following purposes:

  • To drain out cerebrospinal fluid in case of hydrocephalus by inserting a shunt into the ventricles
  • To treat Parkinson’s disease by inserting a deep brain stimulator (DBS)
  • To insert an intracranial pressure monitor
  • To conduct needle biopsy, where a small sample of abnormal tissue is removed for study
  • For stereotactic hematoma aspiration, in which a blood clot is drained out
  • For insertion of an endoscope to clip aneurysms and for the removal of small tumors

When there are complex craniotomies involved, the procedure may be referred to as a skull base surgery.  In this kind of surgery, a small portion of the skull is removed from the bottom of the brain. This is the region where delicate arteries, veins, and cranial nerves exit the skull. Complicated planning is done to plan such craniotomies and understand the location of the lesions. This type of approach is usually employed for:

  • The removal or treatment of large brain tumors and aneurysm in the brain
  • Treatment after a skull fracture or major injury like a gunshot
  • The removal of a malignant tumor affecting the bony skull

Primary brain tumors are much less common than secondary brain tumors. Primary ones are found to originate very close to the brain itself or in the tissues very close to it, such as the covering membranes of the brain, including the meninges, cranial nerves, pineal, or pituitary gland. It begins with normal cells, which at a later period undergoes some mutational errors in their DNA. The mutation triggers cells to grow and divide at a very high rate while healthy cells keep dying around it. This results in a mass of abnormal cells which gives rise to a tumor. Unlike primary tumors, the secondary tumors begin as cancer elsewhere and spread to the brain.

Symptoms of brain tumor

  • Different patterns of a headache
  • Headaches get more frequent and acutely painful
  • Nausea
  • Blurred vision, double vision, or loss of peripheral vision
  • Loss of sensation in the arm or any leg gradually
  • Balance difficulty
  • Speech problems with confusion in simple matters
  • Hearing problems
  • Personality change
  • Sudden seizures and attacks or bouts of pain

Types of Craniotomy

No matter what the goal of the surgery is, it is best to ensure that the incision is made to address the intracranial lesion keeping some principles in mind. A wide variety of intracranial processes can be done via a craniotomy with a different variety of incisions. Some of these variations include frontal craniotomy, pterional craniotomy, temporal craniotomy, decompression craniectomy, and suboccipital craniotomy.

  • An intravenous line is first placed in the arm and general anaesthesia is employed while the patient lies on the operating table.
  • When the patient is no more awake, the head is placed in a 3-pin skull fixing the device. This is attached to a table and keeps the head in a fixed position all throughout the procedure.
  • An insertion of a lumbar drain is made in the lower back to drain out the cerebrospinal fluid. A relaxation drug for the brain named mannitol can be administered at this stage.
  • With an antiseptic, the skull is prepared and an incision is made usually behind the hairline. A good cosmetic result is achieved after the surgery and a hair sparing technique, which requires shaving only one-fourth inch-wide area along the incision proposed is aimed. At times, the total area of the incision may be shaved.
  • The skin and muscles are then removed from the bone and folded back, burr holes are made in the skull using a drill.
  • A saw is introduced through the holes made and cuts the bone flap’s outline. The protective covering of the brain named dura is exposed after the craniotome (the saw) removes the bone flap. This bone flap is kept aside securely to be attached back again after the surgery.
  • Once the dura is opened with surgical scissors, the surgeon folds it back to access the brain. There are retractors placed on the brain to have a corridor opened gently in the brain to address the region requiring removal or repair. 
  • Loupes are used by neurosurgeons, which are special magnifying glasses or an operating microscope to get a view of the delicate nerves and vessels.
  • The brain is very tightly enclosed within the skull and hence, removal of tissues cannot be done easily to repair problems.
  • Therefore, a variety of tools and instruments are employed to work in the deep circuits of the brain like drills, lasers, ultrasonic aspirators (used to break tumours and have the pieces suctioned), dissectors, long handled scissors, and of course computer-aided guidance.
  • Evoked potential monitoring may also be employed to stimulate the specific cranial nerves and the responses generated are monitored. This step ensures that the nerves are functioning properly and not getting damaged as a result of the surgery.
  • After the problem is rectified, the retractors are released and dura is closed along with sutures and the bone flap is placed in its original position and secured with titanium screws and plates. These screws and plates remain permanently in place to support the region and can be felt under the skin.
  • A drain can also be kept as is for some time. It helps collect blood and fluids from the area that is subjected to the surgery. T
  • he skin and muscles are sutured together and a soft turban-like adhesive is placed as dressing over the incision.
  • The patient is shifted to a recovery room where vital signs are monitored after he or she is in complete senses and the effect of the anaesthesia completely wears off.
  • Drowsiness, nausea, and headache are common in craniotomy recovery surgery. Hands, fingers, and toes must be moved frequently to avoid the formation of blood clots.
  • Anticonvulsant medications may be provided and a nurse may keep asking simple questions to figure out alertness.
  • Hospital stay varies from two to three days or even two weeks, depending on the complications that may result.
  • After discharge, keep away from strenuous activities. Some exercises may be prescribed for the slow movement of head and neck.
  • You should notify your doctor about any increase in temperature or infection observed at the sites of the incision. Bathing instructions should be strictly followed.
  • It almost takes around two to eight weeks for complete recovery. Keep visiting your doctor for follow-up checkup or as instructed. Contact your doctor immediately in case of loss of mental function, stroke, seizure, or nerve damage.

Frequently Asked Questions

A craniotomy is performed by making a small burr hole incision, a keyhole incision which is comparatively larger than the former, or a larger incision, as required. The complexity of the surgery depends on the region of the brain which is affected and the severity of the disease or the injury. A craniotomy is performed by the following procedure:

  • The candidate has to remove all kinds of jewelry and accessories and change into the hospital gown.

  • An intravenous line is made on the arm for providing medications and also fetching blood samples.

  • Foley catheter is inserted in the urinary bladder for storing the urine and the candidate is made to lie on a suitable position so as the damaged portion of the brain can be easily accessed. 

  • Anesthesia is provided to the individual and the oxygen level, heart rate, as well as blood pressure, is closely monitored by the anesthesiologist.

  • The incision area and ¼ inch area on either side of the incision is clean shaved and sterilized with antiseptic.

  • A 3-pin machine is used for fixating the skull and holding the head still.

  • Skull drilling machines are used to create necessary burr holes and a craniotome (saw) is used for removing the bone flap to expose the dura mater (outermost protective brain layer)

  • The dura matter is cut open to access the brain. Loupes, dissectors, scissors, drills, etc., are used to penetrate deep and operate.

  • After completion, the dura matter is stitched back in position and the bone flap is fixed via metal plates made up of titanium and necessary screws. 

  • Temporary tubes may be provided for draining of fluid for the next few days.

The candidacy for craniotomy surgery is primarily important and is decided solely by the neurosurgeons. The deciding criteria which make an individual eligible for craniotomy are:

  • Failure of prior treatments and medications in curing the disease or the injury.

  • The candidate shows no sign of long-term or terminal illness.

  • The candidate should not have any serious sickness apart from the brain ailment.

Singapore is globally recognized as one of the topmost countries that offer unparalleled medical treatments in complex operations like craniotomy. The use of contemporary technology, flamboyant facilities, and globally acclaimed surgeons has made craniotomy in Singapore one of the best in the world. The clinics performing craniotomy for decades are:

  • Mount Elizabeth Hospital

  • Gleneagles Hospital

  • Mount Elizabeth Novena Hospital

  • Parkway East Hospital

The surgeons performing craniotomy in Singapore are renowned neurosurgeons with experience of over decades. Decorated with specialists degree from topmost universities in the world, the surgeons have now made the impossible possible. Hence, here are some of the popular surgeons who have excelled the odds in craniotomy.

  • Dr. Ivan Ng

  • Dr. Lee Kam-Yiu Timothy

Craniotomy cost in Singapore of anywhere in the world varies as per the complication and extent of surgery required. Apart from that, the cost is also determined by laboratory tests, multispecialty healthcare benefits, medical facilities, and several other factors. Considering the aforesaid factors, craniotomy cost in Singapore has been estimated to be approximately  USD $6807. 

The post-surgery recovery time for craniotomy requires up to two weeks of observation and follow-ups. Henceforth, complete recovery of the candidate is expected to be achieved within 6 to eight weeks. However, the entire process of recovery depends on how the body responds to resuming activities. In case the candidate needs consecutive chemotherapy or other radiation treatments, the recovery time may be prolonged.

The success rate of craniotomy in Singapore varies approximately from 95% to 99%. The rate varies as per the extent of complications and the part of the brain that is affected, diseased or injured. However, the longevity is quite unpredictable in case of lesions or tumors.

There are several reasons for considering craniotomy in Singapore. These are:

  • Affordable treatment which is cheaper compared to other major countries like the USA, Israel, etc.

  • Multispecialty healthcare

  • Advanced technology

  • Competent surgeon

  • Implementation of modern advancements in medical science

There are several in-general risk factors associated with every operation. Commonly, severe infections, excessive blood loss, and formation of blood clots may occur. Apart from that, the risks specifically associated with craniotomy include:

  • Brain stroke

  • Seizures

  • Leakage of cerebrospinal fluid or the CSF

  • Impaired nerve function

  • Swelling of meninges or affected the portion of the brain

  • Improper nervous reflexes

Singapore is generally known for its well-managed health care infrastructure and has an efficient and widespread system of healthcare. Singapore was ranked 6th in the World Health Organization's ranking of the world's health systems in the year 2000. Bloomberg ranked Singapore's healthcare system the most efficient in the world in 2014. Three main healthcare groups exist in Singapore:
  • National Healthcare Group
  • National University Health System
  • SingHealth
The 10 public hospitals in Singapore comprise 8 general hospitals (AH, SGH, NUH, CGH, TTSH, KTPH, NTFGH & SKH), and 2 specialized hospitals (KKH & IMH). In addition, there are 9 national specialty centres for cancer (NCCS & NCIS), cardiac (NHCS & NUHCS), eye (SNEC), skin (NSC), neuroscience (NNI) and dental care (NDCS & NUCOHS). The private healthcare infrastructure in Singapore is also well established. The payment methods include private payment gateways or private insurance companies. You can expect better technology to be used in private hospitals in Singapore. Various procedures like stem cell therapy and cancer research are conducted in Singapore.
The Joint Commission International (JCI) is a global leader in health care accreditation. JCI accreditation is considered a gold standard in worldwide health care. It provides the most skilled and experienced healthcare professionals in the medical industry, as evaluators of the rigorous international standards in healthcare quality and patient safety. Here are some of the JCI certified hospitals in Singapore :
  • Mount Elizabeth Hospital
  • Singapore National Eye Centre
  • National Dental Centre
  • Raffles Hospital
  • National University Hospital
  • Gleneagles Hospital
  • Singapore General Hospital
  • National Heart Centre Singapore
  • Changi General Hospital
  • National Cancer Centre
  • National Skin Centre
  • Johns Hopkins Singapore International Medical Centre
  • Tan Tock Seng Hospital
Since Singapore is known all over the world for some of the best medical treatments all across the globe, you can surely expect the best quality of doctors and surgeons here. This country has a very high quality of life and hence the health of people is of high priority.
People who wish to go to Singapore as a tourist for social purposes or seeking medical treatment, and require a longer period of stay beyond the Visit Pass granted on entry into Singapore, may submit an application for extension of stay (not more than 89 days from date of entry) online using the e-Service of ICA. All extension applications must be submitted online using the e-service at least seven days prior to the expiry of the visit pass to avoid overstaying. Extension of visit will not be accepted over the counter. Every visit pass issued to any person as a tourist or for the purpose of a social visit or medical treatment shall be subjected to the condition that the holder shall not engage in any form of employment (paid or unpaid) or in any business, profession or occupation in Singapore during the validity of that pass unless he is a holder of a valid work pass issued under the Employment of Foreign Manpower Act. Do visit the ICA website for further information.
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