Description[edit | edit source]

Diagram showing a craniotomy

A craniotomy is an operation where a part of the skull is removed in order to perform surgery on the brain[1]. If the removed part of bone is not put back, the operation is instead called a craniectomy, and the following surgery where the skull is reconstructed is called a cranioplasty[2].

Indication[edit | edit source]

A craniotomy may be used in the treatment and/ or diagnosis of a number of conditions including[3][2]:

  • Brain tumors.
  • Brain haematoma.
  • Aneurysms.

Blood clots.

Types of craniotomy[edit | edit source]

Craniotomies can be classified by the location, size or surgical technique[4]

Skull Bones.png

The location classifications are[5]:

  • Orbitozygomatic

The size can range from the smallest, a Burr Hole craniotomy or a keyhole craniotomy, to operations with bone flaps that are multiple centimeters in diameter[4][6].

Another type of craniotomy is an awake craniotomy, where the patient is woken up during the procedure[7].

the following video shows 3D animation of craniotomy procedure:


Post-Op Physiotherapy[edit | edit source]

The level of physiotherapy intervention and rehabilitation post craniotomy varies widely, and is influenced by a number of factors including the actual surgery, the condition which is being treated, the patients' pre-morbid condition and also the general effects of being in hospital[9].

Generally, the goals of physiotherapy post craniotomy are to maintain and/ or increase range of motion and muscle strength, reduce and prevent spasticity and contractures, functional transfer or gait training, and to improve balance and coordination[10].

Gait rehabilitation.png

Within Neurological Intensive Care Units, physiotherapy intervention is both safe and beneficial[11]. The benefits include decreased length of hospital stay, decreased time on ventilation, improved muscle strength and increased independence in activities of daily living[12][13]. It has been found patients undergoing intracranial pressure monitoring received less frequent and intensive physiotherapy[11], despite the evidence standard physiotherapy practice is safe for these patients[14][15]. At present there are no set protocols for physiotherapy post craniotomy[16], and instead care is directed by the physiotherapists' assessment findings.

There can be long term impairments to a patient's function and quality of life[17][18], for which they might require ongoing physiotherapy intervention. Rehabilitation programs should be tailored to the individual patient abilities, prognosis and goals[19].

Resources[edit | edit source]

Brain & Spine Foundation Craniotomy Factsheet

References[edit | edit source]

  1. Brain & Spine Foundation. Craniotomy Factsheet.
  2. 2.0 2.1 Fernández-de Thomas RJ, De Jesus O. Craniotomy. Treasure Island (FL): StatPearls Publishing, 2022
  3. Johns Hopkins Medicine. Craniotomy.
  4. 4.0 4.1 Neurosurgeons of New Jersey. Understanding the Types and Purpose of Craniotomy.
  5. Rao, D., Le, R. T., Fiester, P., Patel, J., Rahmathulla, G. An Illustrative Review of Common Modern Craniotomies. Journal of clinical imaging science. 2020: 10; 81.
  6. Nahed B.V., Oglivy C.S., Anterior Circulation Aneurysms. In: Mohr J.P., Wolf P.A., Grotta J.C., Moskowitz M.A., Mayberg M.R., Kummer R.V. (editors). Stroke (Fifth Edition). W.B. Saunders, 2011. p.1301-1321.
  7. Medindia. Craniotomy.
  8. Amerra Medical. Craniectomy brain surgery - 3D animation . Youtube; 2020.
  9. Taylor B.S., Kellner C.P., Connolly, Jr. E. Postcraniotomy Complication Management. In: Lee K.(editor) The NeuroICU Book (Seconds Edition). 2017.
  10. Neurosurgery. Available from: (Accessed 14/06/2022)
  11. 11.0 11.1 Sottile PD, Nordon-Craft A, Malone D, Luby DM, Schenkman M, Moss M. Physical Therapist Treatment of Patients in the Neurological Intensive Care Unit: Description of Practice. Phys Ther. 2015; 95:1 006-1014.
  12. Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil. 2013; 94: 551–561.
  13. Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S. Bittner E. et al. Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession. PM&R. 2011; 3: 307–313.
  14. Brimioulle S, Moraine JJ, Norrenberg D, Kahn RJ. Effects of positioning and exercise on intracranial pressure in a neurosurgical intensive care unit. Phys Ther. 1997. Dec; 77: 1682-9
  15. Anneli Thelandersson. Early Physiotherapy in the Neurointensive Care Unit Passive Physiotherapy Interventions [Dissertation] Gothenburg: University of Gotherburg. 2016
  16. Srivastava A., Sharma N., Srivastav A K., Gehlot A. Functional rehabilitation in intensive care units for post craniotomy patients: study protocol. J. Physiother. Res. 2021: 11: 569-582
  17. Pfefferkorn T, Eppinger U, Linn J, Birnbaum T, Herzog J, Straube A. et al. Long-Term Outcome After Suboccipital Decompressive Craniectomy for Malignant Cerebellar Infarction. Stroke. 2009; 40: 3045-3050
  18. Mandona L, Bradaïa N, GuettardaI E, Bonana I, Vahedib K, Bousserb MG, et al. Do patients have any special medical or rehabilitation difficulties after a craniectomy for malignant cerebral infarction during their hospitalization in a physical medicine and rehabilitation department? Annals of Physical and Rehabilitation Medicine. 2010; 53: 86-95
  19. Parreiras de Menezes KK. Physical Therapy Rehabilitation after Traumatic Brain Injury. J Neurol Neurophysiol. 2016; 6: 311