Hydrocephalus is a neurological disorder that causes excess fluid to build up in the brain. This can lead to pressure on the brain, which can cause problems with normal functioning.
People with hydrocephalus experience symptoms like headaches, nausea, vision problems, and/or neck pain. The severity of symptoms varies from person to person.
Surgery is one treatment option for hydrocephalus. When performing surgery to treat hydrocephalus, the neurosurgeon must remove the excess fluid while keeping the brain tissue intact. This is where the term “incision into the skull to drain fluid” comes from!
Surgery can be performed in various ways depending on how much excess fluid needs to be removed and what part of the brain needs to be repaired. There are many different types of surgery for hydrocephalus depending on these factors.
Craniofissure
Craniofissure is the surgical term for opening the skull via incision. It can be used to drain CSF fluid or to surgically remove a section of the skull to access the brain.
Craniofissure is typically performed during craniotomy surgery. During this surgery, the surgeon removes a section of the bone of the skull to access the brain.
Like craniotomy, craniofissure is an invasive procedure that carries risks. These risks include blood loss, infection, neurological complications, and cosmetic concerns. The surgeon will discuss these risks with you prior to deciding whether or not to proceed with the surgery.
Craniofissure can be performed using various surgical tools depending on where in the skull the incision is made and what needs to be done behind the skin and bone. Depending on what type of craniotomy is being done, cranofission may or may not be performed.
Craniectomy
The term craniectomy refers to the removal of a part of the skull. This can be done to remove a cancerous tumor, to relieve pressure and swelling, or in cases of traumatic injury.
Surgeons perform craniectomies as part of the treatment for some brain tumors, including glioblastoma and acoustic neuroma. Patients who receive a craniectomy for a brain tumor may need repeated surgery if the tumor returns.
Craniectomies are also performed in cases of infection or stroke, where the tissue that needs to be removed is diseased. In these cases, the surgery is considered neurosurgery intervention for disease control.
Removing part of the skull can be a complicated surgical procedure that requires careful planning. The surgical team must make sure to take time to plan so that they can ensure patient safety during the procedure.
Craniopharingiostomy
A craniopharingiostomy is a surgical procedure that involves making an incision into the skull and removing some of the bone to access the interior of the skull.
This opening is then expanded by the surgeon to remove any buildup of fluid or blood and allow it to drain. The surgeon will then re-expand the scalp over the exposed area.
This surgery is typically performed when someone has idiopathic intracranial hypertension (IIH). IIH is a condition that causes pressure inside the skull to increase, which can lead to vision loss or stroke. The surgery is performed to help lower this pressure.
While this surgery can be lifesaving, there is a risk of complications such as infection, bleeding, and neurological damage. Your doctor will go over these with you before deciding whether or not to have the procedure.
Frontal craniotomy
A surgical procedure to treat swelling in the brain is called a craniotomy. This procedure can be performed via an incision in the scalp (called a frontal craniotomy) or through the top of the skull (called a lateral craniotomy).
Surgeons perform a frontal craniotomy by making an incision in the scalp and then lifting the skin and tissue away from the bone of the forehead (called the frontal bone).
Underneath this bone is the thin layer of tissue called the dura mater. The surgeon then cuts into this dura mater to access the underlying tissue and brain.
By doing so, they can remove excess fluid that has accumulated there due to increased pressure in the brain. Once enough fluid has been removed, the surgeon will stitch up the incision in the dura mater and frontal bone to help them heal correctly.
Lateral craniotomy
A lateral craniotomy is a surgical incision made along the side of the skull. This type of craniotomy is most often used to access the frontal lobe of the brain.
Like most procedures, a lateral craniotomy has several variations depending on the surgeon performing it and the part of the brain they are attempting to access.
All versions require a sharp incision along the scalp and bone to expose the frontal lobe, however. The difference lies in how much of the exposed bone is removed. Some surgeons leave some bone in place to protect the internal structures, while other surgeons remove all of the exposed bone for access.
Because this procedure can vary so much depending on what part of the brain is being accessed, there are few general recovery guidelines. Most patients experience some headache and nausea following surgery, however these symptoms usually subside quickly.
Temporal craniotomy
Temporal craniotomy is the surgical term for making an incision into the skull to drain excess cerebrospinal fluid. This surgery is typically performed to manage increased intracranial pressure (ICP) due to a brain tumor or head injury.
Temporal craniotomy is typically performed via an anterior approach, or from the front of the head. A posterior approach, or from the back of the head, can also be used. Anterior approaches are less common due to risk of bleeding.
During this procedure, the surgeon will make a circular incision in the bone of the temple (also known as the temporal bone). The surgeon will then use special tools to carefully cut through the innermost layer of bone (dura) to access and remove excess CSF. The dura and any tumor or bleed are then repaired using stitches or a patch.
) Orbitozygomatic craniotomy
This surgical term means “incision into the orbit and zygomatic bone to access the skull.” The orbit is the bony structure that surrounds the eye. The zygomatic bone is in the cheek area.
This procedure is typically performed to access the brain via the skull. This can be to remove fluid accumulation, diagnose why it’s there, or surgically treat it.
Orbitozygomatic craniotomy can also be done for other reasons such as neurological surgery or tumor removal. Tumor removal can be done using both traditional surgery and using laser technology.
Surgery can be very challenging and requires a team of doctors, nurses, and specialists to do it safely.
Frontotemporal transorbital decompression (FTTD)
A recently developed surgical term is Frontotemporal transorbital decompression (FTTD). This is the name for a procedure that surgeons are beginning to use more often in place of craniotomy.
FTTD is a more specific name for the procedure that describes where the incision is made and how far into the skull it goes.
Surgeons use this term because it describes the exact movement of the bone as well as where the incision is made.
Healing time and post-surgical care are similar between the two procedures, however, patients typically have less post-surgical headaches with FTTD due to how it is designed.
It continues to be tested against other procedures, but many surgeons are confident in its effectiveness and safety so it is becoming more popular.
