Craniotomy Cost in South Africa

A craniotomy involves surgically removing a portion of the skull to access the brain. During this procedure, specialized instruments are used to extract a section of bone, known as the bone flap. This bone flap is temporarily removed and reattached.

Some craniotomy procedures incorporate computer and imaging technologies, such as magnetic resonance imaging (MRI) or computerized tomography (CT) scans, to accurately target the specific brain area needing treatment. This advanced technique may involve the use of a frame fixed to the skull or a frameless system with surface markers or landmarks on the scalp. When these imaging methods are used in conjunction with the craniotomy, the procedure is referred to as a stereotactic craniotomy.

Types of Craniotomy:

• Extended Bifrontal Craniotomy: It is a traditional skull base approach involving an incision behind the hairline and removal of forehead and orbital bone to safely access front brain tumors, such as meningiomas, esthesioneuroblastomas, and malignant skull base tumors, without unnecessary brain manipulation. This technique is used when minimally invasive methods are unsuitable.
• Minimally Invasive Supra-Orbital “Eyebrow” Craniotomy: Supra-orbital craniotomy, also known as "eyebrow" craniotomy, is a method to remove brain tumors via a small incision above the eyebrow, particularly for tumors near the pituitary gland or optic nerves, substituting endonasal endoscopic surgery for large or critical cases.
• Retro-Sigmoid “Keyhole” Craniotomy: It is also known as "keyhole" craniotomy, is a minimally-invasive procedure for removing brain tumors via a small incision behind the ear, facilitating access to the cerebellum and brainstem, particularly useful for tumors like meningiomas, acoustic neuromas, skull base tumors, and metastatic brain tumors, offering benefits such as reduced postoperative pain, minimal scarring, and quicker recovery compared to open craniotomies.
• Orbitozygomatic Craniotomy: It is a traditional skull base approach, that involves removing bone around the orbit and cheek to access complex brain tumors and aneurysms, minimizing brain manipulation and enabling deeper surgical reach.

• During a craniotomy procedure, the patient undergoes several preparatory steps. They are asked to remove any clothing, jewelry, or objects that could interfere with the surgery and are provided with a gown. An intravenous (IV) line is inserted into the arm or hand for medication administration, and a urinary catheter is inserted to drain urine. Once positioned on the operating table for optimal access to the affected side of the brain, the patient's vital signs are continuously monitored by the anesthesiologist, including heart rate, blood pressure, breathing, and blood oxygen levels.
• Next, the surgical site is prepared by shaving the head and cleansing the skin with an antiseptic solution. Depending on the location of the problem, various types of incisions may be made, often behind the hairline or in another location. The scalp is then pulled up and clipped to control bleeding, allowing access to the skull. Burr holes may be made with a medical drill, and the bone flap is carefully removed and saved. The dura mater, the thick outer covering of the brain, is separated from the bone and opened to expose the brain. Microsurgical instruments may be used for better visualization, enabling the surgeon to distinguish between abnormal and healthy tissue and take tissue samples for testing.
• During the surgery, a device such as a drain or monitor may be placed in the brain tissue to measure intracranial pressure. Once the procedure is completed, the layers of tissue are sutured together, and the bone flap is reattached using plates, sutures, or wires. In some cases, the bone flap may not be replaced, particularly if a tumor or infection is present, or if decompression is required. The scalp incision is closed with sutures or surgical staples, and a sterile bandage or dressing is applied over the incision site.

After the craniotomy procedure, patients are typically transferred to either a recovery room for initial observation or directly to the intensive care unit (ICU) for close monitoring. In the ICU, medications may be administered to reduce brain swelling, and vital signs like blood pressure, pulse, and breathing are closely monitored until stable. Once patients regain alertness and their vital signs stabilize, they may transition to a neurosurgical nursing unit within the hospital for further recovery, where they will stay for several days. During this time, patients receive frequent neurological assessments to evaluate brain function, including responsiveness to commands, pupil reactions, and strength testing of limbs. The head may be elevated to reduce facial and head swelling, and patients are encouraged to gradually increase mobility with assistance as needed, under the guidance of medical staff and possibly a physical therapist.

Following discharge from the hospital, patients are advised to keep the incision clean and dry, following specific bathing instructions provided by their doctor. Any stitches or surgical staples are typically removed during a follow-up office visit, and patients may opt to wear a loose turban or hat to protect the healing incision. Pain management is important, with recommended pain relievers used cautiously to avoid complications like bleeding. Patients are also instructed to continue breathing exercises to prevent lung infections and to gradually increase physical activity as tolerated, understanding that it may take several weeks to fully regain energy and strength. Additionally, they are advised to avoid exposure to respiratory infections and irritants like tobacco smoke to promote optimal recovery.