Craniotomy Treatment Cost in India

A craniotomy is a process by which part of the bone from the skull is removed for exposing the brain.  The bone flap is removed with the help of specialized tools. The flap is temporarily removed and then again placed back in position at the end of the surgery.

Some procedures can take the aid of computers and imaging or MRI or CT scans to exactly reach the region of the brain that needs treatment. A-frame has to be used onto the skull or a frameless system must be in place for markers or landmarks on the scalp.  When any of the above procedures are employed for the craniotomy procedure, then it is referred to as stereotactic craniotomy.

A three-dimensional image is formed with the help of the scans made of the brain along with localizing frames. For example, while treating the tumor, it is helpful in differentiating between healthy and abnormal tumor tissue inside the brain.

Specific techniques may be used for brain stereotactic biopsy when the needle is directed in an irregular region, enabling examination of microscopic, stereotactic (e.g. Gamma knife radiosurgery) or stereotactic (cyst reduction, hematoma, and abscess) tissue ambitions to be removed.

The technique is called endoscopic craniotomy if a light-weight instrument with a camera is inserted into the brain through a small incision inside the skull.

In aneurysm clipping, a craniotomy may be required.  A building weakened region formed in the wall of the artery which suffers the risk of bursting. A metal clip is placed across the neck of the aneurysm to keep the region away from the remaining circulatory system thereby preventing blood flow from it and subsequent rupture.

There can be different types of craniotomy and they are summarized below:

Extended Bifrontal Craniotomy:  This is a traditional skull base approach used for targeting difficult tumors existing in front of the brain. This observes the principle of removing extra bones than manipulating the brain.

An incision is made in the scalp running behind the hairline and then, the bone that forms the contour of the orbits and forehead is removed.  The bone is again placed back after the surgery.

Minimally invasive Supra-Orbital “Eyebrow” Craniotomy: In this case, an incision is made within the eyebrow for access to the tumors in the front of the brain or even called pituitary tumors. This method is a substitute against endonasal endoscopic surgery when the tumor to be treated is large and near optic or vital nerves. Due to its minimally invasive nature, it helps in healing quickly and minimum scarring is caused.

Retro Sigmoid Keyhole craniotomy: This is again a very minimally invasive surgery used for removing brain tumors. Skull base tumors are removed with the help of a small incision made behind the ear getting access to the brainstem and cerebellum. Meningiomas and acoustic neuromas can be addressed with the help of this technique.

Orbitozygomatic Craniotomy:  This is a traditional skull base technique aimed to attend aneurysms and difficult tumors of the brain. Here an incision is made behind the hairline and bone is removed that form contour of the orbit and cheek.

At the end of the surgery, it is again placed back. Craniopharyngiomas, meningiomas and pituitary tumors are removed with the help of this technique.

Translabyrinthine Craniotomy: In this case, the incision is made behind the ear and mastoid bone of the inner ear is removed ( semicircular canals housing balance receptors). After this, the tumor is accessed and removed. Acoustic neuroma is treated in this method. In this process hearing loss is unavoidable, but any facial nerve injury can be avoided or reduced.

A craniotomy can be performed and recommended for a number of reasons that are listed below:

• Brain tumor treatment, removal or diagnosis. Symptoms can include pain in the head or loss of memory.
• Aneurysm clipping(Procedure conducted to treat a balloon-like bulge of an artery wall known as an aneurysm) and repairing
• Blood or blood clots removal from a leaking blood vessel in the brain
• Removal of arteriovenous malformation
• Repair of skull fractures
• Draining of brain abscess or an infected pus-filled pocket
• Repairing any tear in the dura mater (a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord)
• Release of extra pressure built up in the brain
• Epilepsy treatment which has symptoms like seizures
• For the treatment of movement disorders like dystonia or Parkinson’s disease where a stimulator implant is required.

Craniotomy surgeries can require a hospital stay of 3 to 7 days. Depending on the condition of the patient and the practices adopted by the doctor one’s craniotomy procedural steps may vary.

An IV line is started either in the hand or arm of the patient. A urinary catheter is inserted for emptying the bladder of urine. The anesthesiologist will be checking the blood pressure, heart rate, and breathing and oxygen level continuously during the method.

The patient’s head is shaved off and the skin over the surgical site will be cleansed with the help of an antiseptic solution. The patient is properly positioned on the operating table for the best access.

There are many ways in which incisions can be done based on the affected region of the brain that needs to be treated. One type of incision can be made behind the hairline in front of the ear and the nape of the neck or in any other location based on the problem. Incisions are smaller if an endoscope is used.

With the help of a tool, the head is held in one single position till the end of the surgery.

The scalp is pulled and clipped for bleeding control and access to the brain is thereby provided. For making burr holes in the skull, a medical drill is used and a special saw for careful cutting of the bone.

The flap of the bone is removed and saved in a secure place. The thick outer covering of the brain directly under the bone called dura mater is segregated from the bone and it is cut open to get the brain exposed.

If required excess fluid is allowed to flow out of the brain and microsurgical instruments that are there to magnify the region can also be employed. A better view of the brain structures will allow the surgeon to differentiate between abnormal tissues and healthy tissues. Tissue samples are sent to the lab for the purpose of testing.

Measurement of pressure inside the skull or intracranial pressure (ICP) has to be measured for which a device or drain with a special kind of monitor is placed. Inside the closed the pressure created by the blood supply and cerebrospinal fluid on the brain tissue.

After the removal and correction work is done, the surgeon will sew or suture the layers of tissues together.

The bone flap is reattached with the help of plates sutures and wires. If a tumor or an infection is found inside the bone then the flap may not be replaced. Also, in a situation where the brain pressure has to be reduced, in such condition to the flap may not be placed.

Thereafter the skin incision is closed with the help of sutures and surgical staples. A sterile dressing or bandage is applied over the incision.

Since craniotomy is used for various reasons, its alternatives can be decided and that must be explored by the patient and his or her family before going for the procedure. For diagnosis of brain disorders, one can consider cerebral arteriogram, CT scan of the brain, MRI or Magnetic Resonance Imaging of the brain, Electroencephalogram or EEG, PET or positron emission tomography and full X-rays of the skull.

The above diagnosis procedures are all mainly non-invasive types of methods compared to craniotomy.

After confirmation that craniotomy is the only surgery option for any patient, the doctor will study in detail the medical history of the patient. Any medication that the patient is being administered may be altered. If the patient is allergic to any known dye or medication, that must be clearly communicated to the health care provider. Pregnant women should convey about pregnancy or even communicate if they are just expecting pregnancy. 

The patient may be given some antiseptic shampoo to wash their hair with just the night before the surgery. The hair has to be completely shaved off just after the patient has been placed on the operating table.  Apart from that, the patient will be asked to fast prior to surgery. It is important to have someone from family or friends to accompany the patient during the whole stay.

After the procedure, the patient is shifted to the recovery room and thereafter to the intensive care unit for close monitoring. Over there to drain the brain swelling, medicines are given. Depending on the type of procedure and anesthesia administered the process of recovery will vary.

With the stabilization of heart rate and breathing, the patient is shifted to a neurosurgical nursing unit of the hospital where for several days the patient will be taken care of. The patient will require oxygen after the surgery for some time. Once the patient grows alert he or she will be taught deep breathing exercises to expand the lung and prevent contracting pneumonia.

Neurological tests during the stay is normal and will be conducted frequently by the medical staff. The patient will be given simple movement tasks of hands and legs to see whether the patient is able to follow simple instructions or not. Eye pupil will be checked with flashlight and questions are asked to assess the orientation. Arms and legs’ strength will be tested.

To prevent swelling of face and head, the bed where the patient is lying will be elevated. If required, a physical therapist will be appointed to check the movement of the body and test balance and strength.

Sequential compression devices may be placed on legs to prevent blood clot formation. These devices work by slowly pumping air on the fitted sleeves which puts pressure on the veins and which in turn aids in the movement of blood.

Gradually normal food is introduced in the diet. A catheter is placed for the removal of urine until the patient is fit to move around. If there is any pain noticed during urination, then it must be reported as the reason can be due to some infection that can be treated.

A detailed plan is charted out that must be followed at home to aid in recovery and a follow-up visit plan has to be strictly adhered to.

The incision must be kept clean and dry once the patient is at home and no wig or false hair should be worn until the incision has completely healed (may take 3 or 4 weeks). The breathing exercise must be continued and no smoking and getting in touch with fumes or pollution that can irritate mucous membranes and cause coughing since hat will cause trouble at the site of the incision.

Gradually physical activities have to be increased and strain on surgical incision has to be avoided. Healthcare provider must be informed if the following troubles are noticed

• Vision change
• Swelling or redness in face or incision site
• Fever
• Pain in the incision site
• Too much of sleepiness or confusion and convulsions
• Arm weakness and problems in speech
• Chest pain, breathing problems, change in mental status or anxiety
• Seizures
• Green-yellow or blood shaded phlegm

Cost of craniotomy is 10 times lower in India compared to that in the USA and the quality is the same.  The cost is around $4500.