Professor Tzvi Ramleading neurosurgeon
Craniotomy is the opening of the skull by removing a fragment of the skull. The intervention is performed to provide access to brain tissues and tumours. One of the main indications for performing a craniotomy (trepanation of the skull) is a brain tumour.
For many years, treatment of brain tumours has been carried out in Israel: various surgical interventions requiring craniotomy are performed. Craniotomy for the purpose of removing a brain tumour is carried out by neurosurgeons with the highest qualification category.
There are many indications for craniotomy to access the brain, including various injuries, brain compression, and vascular diseases of the brain, but the most common indication is a tumour process in the brain:
- Benign brain tumours (glioma, meningioma);
- Malignant brain tumours (lymphoma, glioblastoma).
The specialists at Top Ihilov Medical Center have accumulated vast practical experience, and the surgeons are skilled in all modern techniques, with the department equipped with excellent apparatus and equipment. Scientific work is conducted in the department to find more advanced methods of treatment and diagnosis of brain pathologies. Due to the well-deserved reputation of the medical center, patients from dozens of countries come here to receive the highest quality medical care.
How is craniotomy performed in Israel?
To provide the highest quality surgical treatment for brain tumours in Israel at Top Ihilov Medical Center, both craniotomy with removal of a fragment of the skull and gentle craniotomy (a hole is drilled for the introduction of endoscopic instruments during endoscopic intervention) are performed.
The operation is performed under either general or local anesthesia. The type of anesthesia is determined by the need to monitor the patient's condition during the operation. When the tumour is located near vital areas of the brain, local anesthesia is preferred (sometimes general anesthesia is used until entering the cavity, and then the patient is switched to local anesthesia). Patients should not be afraid that they will feel pain; brain tissue is not supplied with pain receptors, and any actions on the brain are painless.
The surgical field is shaved and treated with antiseptic. The soft tissues are opened, and a hole is drilled in the skull, which is then enlarged to the necessary size. This provides access to the brain tissue, and the surgeon locates and removes the tumour. Special endoscopic instruments are used for the removal of the formation, and all actions are monitored by a computer observation system. The tumour is removed in various ways:
- Using a micro-pump (suction);
- Using electrocautery instruments (Bipolar Forceps);
- Using an ultrasonic aspirator;
- By traditional method, excision with a scalpel.
The duration of the operation varies from one to three hours. After the operation, the patient is hospitalized for 5 to 7 days. In the postoperative period, rehabilitation treatment and periodic visits to a specialist are required. The prognosis for treatment is favorable.
Craniotomy under local anesthesia - the revolutionary Awake Craniotomy method
The operation using craniotomy involves the most complete and precise removal of the brain tumour without damaging functionally important areas.
If the tumour is located near speech centers and motor activity zones, the risk of developing surgical complications is very high. As a result of the operation, severe speech disorders or paralysis of the limbs may occur.
Modern surgery has methods to prevent the development of such complications.
The oncological surgeons at Top Ihilov Clinic use a unique method for removing brain tumours that significantly reduces the risk of surgical complications – Craniotomy under local anesthesia.
The surgeon begins the operation under general anesthesia, but during the main manipulation on the brain tissue, the anesthesia is stopped, as the brain tissue itself does not feel pain. Manipulations under local anesthesia do not cause pain sensations. The patient remains fully conscious, which significantly reduces the risk of complications.
A special device - cortical stimulator - may be used to identify problematic areas of the brain during the operation.
If weakness in the limbs or speech disturbances develop under the influence of the stimulator, manipulations in that area of the brain are stopped, which eliminates the occurrence of complications due to manipulations in those areas of the brain.
Diagnosis before surgery using craniotomy at Top Ihilov Medical Center
As with any surgery, before craniotomy, patients must undergo a multi-level examination:
- ECG or other heart function tests (prescribed for all patients over 40 years old and as indicated for patients of any age);
- chest X-ray. For elderly patients – a standard X-ray, for young, non-smoking patients, fluorography may be performed;
- CT of the skull;
- MRI or fMRI (functional magnetic resonance imaging);
- angiography of the brain vessels using contrast agents;
- PET and PET CT (to determine the metastasis process);
- CT angiography.
The patient may be prescribed additional examination procedures to clarify the diagnosis and plan the most effective surgical intervention.
- Brain cyst
- Brain tumours
- Brain cancer