Craniotomy in South Africa

Craniotomy is a preliminary surgical procedure necessarily performed to access the brain and proceed with further operations. It involves the cutting and opening of a portion of the skull in order to have access the brain. It is performed either in case of severe neurological or cerebral anomaly, or in case of traumatic as well as accidental injuries. Craniotomy is also performed to remove lodged foreign objects like iron rods, bullets, nails, etc. 

What is craniotomy?

The surgical removal of a bone flap or a portion of the skull to perform necessary operation on the brain is known as craniotomy. Post-operation, the bone flap is however fixed in position with the help of metal screws. Craniotomy involves carving out minute incisions or burrholes as well as significant incision known as keyholes to carry out necessary functions. The entire procedure is guided by endoscopes, stereostatic framing, as well as computer based imaging that helps the surgeons to:

  • Remove blood clots in case of hemorrhage
  • Draining of excessive Cerebrospinal Fluid
  • Treat brain tumors
  • Relax stressed arteries, veins or nerves
  • Cure an injury
  • Insertion of devices like Intracranial Pressure Monitoring system, Deep Brain Stimutaling devices

Ideal Candidates for Craniotomy surgery 

Evaluation for ideal candidacy for craniotomy surgery is primarily important. The surgeons shall decide an ideal candidate if the individual:

  • Suffers from an advanced stage brain tumor
  • Requires urgent biopsy of an affected brain tissue
  • Suffers from additional intracranial pressure buildup
  • Needs insertion of an artificial device to control brain functioning
  • Has a foreign object lodged in the brain
  • Suffers from hemorrhage 

Factors affecting the cost of craniotomy surgery in India

Craniotomy is mostly performed to treat or remove brain tumors (malignant or benign). An average brain tumor surgery cost may range from $20,000 to $28,000. Apart from tumors, the surgery is performed for a number of other reasons, depending on which, craniotomy cost may range from $8000 to $20000. It may hinge on:

  • Reason for craniotomy surgery
  • Type of craniotomy required 
  • Extent of bone flap removal
  • Extent of post-surgical follow up required
  • Healthcare benefits required
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About the Craniotomy

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.

How is Craniotomy performed?

  • 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.

Recovery from Craniotomy

  • 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.

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Frequently Asked Questions

What is the health care infrastructure of South Africa / Why should opt for South Africa as a destination for your medical treatment?
Like most countries, hospitals in South Africa are based upon public and private healthcare systems. There are three main levels of healthcare based upon the payment method of the patient.
  • The full paying patients are those who usually prefer to be treated by a doctor working in the private sector. They can also be funded by an external source. Many non-South African citizens also prefer this treatment service.
  • Fully subsidized patients are those who have been referred from a Primary Healthcare Service Hospital.
  • Partially subsidized patients are patients whose costs are subsidized based on the amount of their income.
The public healthcare system has three main centers for health under its wing:
  • Clinics - These are run by trained professionals and nurses. They can serve as the first point of contact for a patient.
  • Community Healthcare Centre - This is a bigger setup, complete with full-fledged services and doctors and nurses.
  • Hospital - A patient usually gets here after a referral from a clinic or community health center. One can also go in for emergencies. A hospital provides various services like performing surgery and treating chronic illnesses.
Hospitals in South Africa are gearing up to tackle major illnesses and to provide better treatment options. The South African government is also working to introduce policies and towards accommodating more patients from all across the world. It is a great country to find affordable treatment options.
What are the conditions of the hospitals in South Africa? Are they JCI certified? What is the quality of the support staff in the hospitals
The Joint Commission International (JCI) accredits and certifies most health care organizations and programs all around the world. Joint Commission International Accreditation and Certification is recognized as the global leader for health care quality of care and patient safety.
Are the doctors/surgeons in South Africa of the best quality?
Doctors associated with Medigence are of the best quality. We hope to give our patients a pleasant experience and the best doctors we can find. Since South Africa has a lot of requirements in the field of healthcare, the country attracts doctors from all over the world to contribute their services. This can help to ensure that even you receive the best quality of doctors.
What is the process for obtaining a medical visa in South Africa?
One can apply for a visa to South Africa for a period of 90 days. The High Commission of India can then help one decide for how long a visa can be extended. This usually differs from person to person. The Medical Visa allows a person to stay for a maximum of six months with a valid visa. After this, one can go to the FRO office ( Foreigner’s Registration Office ) or FRRO (Foreigner's Regional Registration Office) and request for an extension. Do note that the validity of a visa begins on the day it is issued by the High Commission of India and not on the date of departure. Applications for visas will not be accepted more than 30 days prior to departure.
What support services does MediGence provide in the United Arab Emirates?
MediGence enables you to plan and manage your medical decisions better. These are some of our services offered:
  • Expert Opinion
    We help you seek an Expert Opinion on your diagnosis and treatment from an experienced team of doctors at MediGence and specialists from a reputable hospital.
  • Hospital Recommendation
    We recommend a hospital or a healthcare institution that is best suited for you, based on your ailment and its criticality.
  • 360-degree Hospital Review
    We give you a transparent and holistic view of the hospital and its infrastructure, accreditation, facilities, and expertise to give you confidence.
  • Doctor Validation and Communication
    We share a comprehensive profile of the treating doctor and also arrange a call to clear queries regarding treatment if needed.
  • Options to Choose From
    Based on your choice of destination and other preferences, we provide you multiple options with respect to hospitals and doctors to choose from.
  • 24X7 Patient Care Support
    A dedicated patient case manager stays in constant touch with you to help you at every step of the decision-making process and resolve queries that you may have.
  • Transparent Treatment Cost and Other Expenses
    We give a clear and accurate indication of the total cost of treatment including treatment, stay, meals, and other expenses.
  • Visa Assistance
    We provide and help prepare documentation for visa approval and coordinate with the embassy to expedite the visa process.
  • Accommodation Arrangements
    We propose to you a choice of accommodation based on your preference such as long stay, short stay, or luxury properties.
Which are the best cities in South Africa for medical treatment?
While many cities are striving to create some of the best hospitals in South Africa, Durban, Lenasia, and Cape Town already have some very good hospitals for treatment in South Africa. Located in Durban, Ethekwini Hospital and Heart Centre is a reasonable and affordable hospital in South Africa. Life Kingsbury Hospital in Capetown provides a holistic healing environment for patients. One can also opt for the Ahmed Kathrada Private Hospital in Lenasia. This hospital has been running for nearly 30 years now and various medical facilities can be availed from here.

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