Craniotomy in Turkey: Cost, Procedure, and Hospitals

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.

Frequently Asked Questions

What is Craniotomy Surgery and what are its main causes?

A craniotomy is a type of brain surgery wherein part of the bone from the skull is removed to access the brain. This type of brain surgery is used to treat a brain tumor, blood clot in the brain and various types of other abnormalities related to the brain. In craniotomy surgery, bone flap (a section of the skull) is temporarily removed by specialized surgical tools and are again placed to their exact position after the surgery gets completed. The main aim of the surgeon is to access that particular portion of the brain which is abnormal. For reaching precisely to the affected area without any damage to the healthy tissues, various diagnostic tools such as CT scan and MRI can be used by the surgeon.

There are several common causes for doing a craniotomy surgery such as:

Aneurysm: Aneurysm is characterized by weakening of blood vessel walls and when blood flows through these walls, the vessels bulge like a balloon.
Brain tumor: Brain tumor is a collection of abnormal cells which starts growing uncontrollably in the brain. These cells may interfere in the physiological functioning of the brain. Malignant brain tumors may be metastatic or primary brain tumors.
Arteriovenous malformation: Arteriovenous malformation is a type of abnormalities caused due to the entanglement of arteries and vein results in poor blood flow and reduced oxygen supply.
Brain injury: Brain injury caused by any blood disorder, swelling of brain and damage to brain tissue.
Brain abscess: Brain abscess is caused due to inflammation and infection inside the brain and the infected material gets collected in the brain tissues.

What is the average cost of Craniotomy in Turkey?

Turkey provided the craniotomy surgery at a highly competitive price as compared to other countries. Well experienced surgeons, top facilities in the hospital, latest technologies, high success rate encourage the medical tourists to undergo craniotomy in Turkey. The average cost of craniotomy surgery in turkey is USD 15,000.

What are the factors affecting the cost of Craniotomy in Turkey?

There are various factors which affect the cost of craniotomy surgery in turkey;

Types of technologies: Types of technologies used during surgery such as cutting-edge robotics, and state of the art technologies affect the cost of craniotomy surgery.
Types of hospitals: Hospitals with huge infrastructure and modern facilities affects the cost of surgery. Location of the hospital is also an important factor.
Hospitals facilities: Hospitals facilities included specialized intensive care units, transportation services, free transfer between the airport, rehabilitation, health insurance co-ordination also affects the cost of craniotomy surgery.
Cost of diagnostic tests: There are several diagnostic tests conducted before and after craniotomy surgery such as computerized tomography (CT scan), magnetic resonance imaging (MRI), angiography, echocardiogram, and electrocardiography. These tests affect the cost of this surgery.
The expertise of specialist: Cost of craniotomy surgery depends upon the experience of the doctor and his success rate.
Medication expenses: Medication cost included anticonvulsants, pain relief, and any other medications prescribed by the surgeon.
Extra services expenses: Extra services include rehabilitation therapy such as physical therapy also increases the overall cost of surgery.
Affected site of the brain: More complex the surgery is, more would be the cost of surgery.
Patient health status: patients health status also affects the cost of this surgery because poor health status leads to increased staying at hospitals and may also increase the risk of complications.

What is the recovery process post-surgery in Turkey for Craniotomy?

After surgery of craniotomy, the recovery process in depending upon these factors;

When craniotomy surgery is done, the patient is shifted in a recovery room where the vital signs are monitored.
The patient is advised to frequently move fingers, hands, and toes to minimize the risk of deposition of a blood clot.
Medications should be administered as directed by the surgeon or the paramedical staff.
After craniotomy surgery, patients should take rehabilitation therapy under the guidance of rehabilitation specialists. Rehabilitation therapy included physical therapy, occupational therapy, and speech-language therapy.
Drowsiness, headache, nausea may be experienced by the patients undergone craniotomy surgery.
If any infection or increase temperature is observed or there is any inflammation at the site of incision, consult with the doctor.
Patients should avoid strenuous activities.
If the patient experiences any reduction in mental function, seizures, nerve damage or stroke, he should consult with the doctor

Which are the top hospitals for Craniotomy Surgery in Turkey?

Following are some of the top Hospitals for Craniotomy Surgery in Turkey:

Lifemed Medical Center, Istanbul, Turkey
Liv Hospital, Ankara, Turkey
Medicana Hospital Groups, Istanbul, Turkey
Hisar Intercontinental Hospital, Istanbul, Turkey
Anadolu Medical Center, Gebze/Kocaeli, Turkey
Acibadem Taksim, Istanbul, Turkey
Medipol Mega University Hospital, Istanbul, Turkey

Who are the top neurosurgeons for Craniotomy Surgery in Turkey?

Following are the most sought after Neurosurgeons for Craniotomy Surgery in Turkey:

Dr. Ali Zırh, Medipol Mega Hastaneler Kompleksi, Istanbul, Turkey
Dr. Mustafa Kemal Hamamcıoğlu, Liv Hospital, Istanbul, Turkey
Dr. Sait Sirin, Medicana Hospital Groups, Istanbul, Turkey
Dr. Murat Cobanoglu, Hisar Intercontinental Hospital, Istanbul, Turkey
Dr. Prof. Serdar Kahraman, Anadolu Medical Center, Gebze/Kocaeli, Turkey

What is the success rate of Craniotomy Surgery in Turkey?

The success rate of craniotomy in Turkey is at par with the developed countries. The success rate of craniotomy surgery in turkey depends upon the following factors;

Types of brain injury: It is one of the most important factors which determine the overall survival rate. Some brain injuries such as meningioma and oligodendroglioma can be treated with high success rates.
Patients age: Age of the patient also affects the success rate of craniotomy surgery. The recovery is faster in younger patients as compared to older patients.
Grades of tumors: The tumors are categorized as low-grade tumors and high-grade tumors. Patients who are diagnosed with low-grade tumors have better outcomes and high success rates after craniotomy surgery.
Incision planning: A variety of incisions are done during craniotomy surgery. If the number of incisions is less, the patient has early recovery.

What is the health care infrastructure of Turkey / Why should opt for Turkey as a destination for your medical treatment?

The healthcare infrastructure of Turkey comprises health centers, health posts, mother and child health and family planning centers, tuberculosis dispensaries, etc. Health centers are each staffed by a team consisting of a doctor, a nurse, a midwife, a health technician, and an administrator. Health posts report to health centers and are each staffed by a midwife. Health centers and health posts are the only settings providing preventive care, health promotion, and community-based health services. All other settings use specialists to provide just primary diagnostic and curative care. Turkey is turning out to be a preferred destination for medical treatment by many people across the world for its pace of development. The people are friendly and the administration is efficient. After the treatment in Turkey, one can even choose to unwind amidst its beauty.

What are the conditions of the hospitals in Turkey? Are they JCI certified? What is the quality of the support staff in the hospitals?

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 a few JCI certified hospitals in Turkey :

Anadolu Medical Center
Hisar Intercontinental Hospital
Medipol Mega University Hospital
NP Istanbul Brain Hospital
Neolife Oncology Center
Liv Hospital
Medicana Healthcare Group
Kadikoy Florence Nightingale Hospital
Istanbul Memorial Hospital
Memorial Antalya Hospital
Taksim Hospital
Dunyagoz Hospitals Group, Istanbul, Turkey
Medical Park Hospitals Group
Medical Park Göztepe Hospital Complex
Acibadem Maslak Hospital
German Hospital Taksim
Medical Park Bahçelievler Hospital
Göktürk Florence Nightingale Medical Center
International Hospital
Aydinlar Dental Group

Are the doctors/surgeons in Turkey of the best quality?

Doctors in Turkey are highly educated and well trained. This is one of the reasons why many people flock to Turkey for medical treatment. The doctors are skilled and can converse fluently in English and other foreign languages.

What is the process for obtaining a medical visa in Turkey?

At present, there are two types of medical visas available for your visit to Turkey:

Medical Visa, which can be obtained from the Consulate of Turkey
Online Visa (eVisa), which can be obtained in advance of arrival via the government of Turkey’s online visa system.

Visitors must obtain a medical visa for traveling to Turkey unless they come from visa-exempt countries and territories or citizens of those countries, which are eligible to apply for an e-Visa online. How To Acquire Online Medical Visas (e-Visa or electronic visa) :

Simply visit www.evisa.gov.tr and apply on the platform by selecting your country and the type of passport or identity card. The platform is self-explanatory and will guide you throughout every step.
Once you are done filling the form, save and download the form for future references.
The applicant must visit the nearby Turkish embassy in his/her country to get the approval of the Consulate.
Once the visa is approved, the travel dates can be scheduled accordingly.

What support services does MediGence provide in Turkey?

MediGence has been praised on a global scale for the list of services they provide. Apart from the listed services, the staff and the guides are adorned for their customer interaction, impromptu assistance, and various other assistance related guidance throughout the tour. Thus, the list of services provided by MediGence are:

Insurance query related guidance
In-detail guidance till completion of the medical tour
Visa Assistance
Free airport to hospital transfer
On-Ground Support
Teleconsultations
Accommodations Assistance
Rehabilitation and recovery services

Which are the best cities in Turkey for medical treatment?

The capital of Turkey is Istanbul. Istanbul is easily accessible and the preferred location for medical treatment. Other cities with good hospitals are Izmit and Bursa.

Craniotomy in Turkey