Craniotomy: What It Is, Why It's Done, Types, Steps and Recovery
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is a craniotomy?
A craniotomy is brain surgery in which a surgeon removes a section of skull, called a bone flap, to reach the brain and treat tumors, aneurysms, bleeding, infections, seizures or injuries. It is done under anesthesia, usually takes three to five hours, and the bone flap is put back with small plates or screws. Recovery takes several weeks to months. [1]
What the research says
Wound infection is uncommon but real after brain tumor surgery. A meta-analysis of 37 studies and 91,907 patients found infection at the surgical site in about 4% of patients by 30 days and about 6% by 90 days. Longer operations, previous radiotherapy, repeat surgery and spinal fluid leaks raised the risk. (Lee et al., World Neurosurgery, 2024) [2]
Awake surgery with brain mapping may protect speech. Pooling 10 studies (833 patients with glioma), awake craniotomy with electrical stimulation cut the risk of lasting language problems by more than half (risk ratio 0.44) and other neurological problems by about half (0.49) at 3 months or later, with shorter hospital stays. (Bu et al., Neurosurgical Review, 2021) [3]
Fewer deficits and shorter stays in high-grade glioma. In 11 studies with 2,689 adults, awake craniotomy was linked to new neurological deficits at 3 months in 13% of patients versus 21% under general anesthesia, and hospital stays of about 4.1 versus 7 days. Most studies were observational, so certainty is low to moderate. (Nowacka et al., Journal of Clinical Medicine, 2026) [4]
Key takeaways
A craniotomy opens a window in the skull so a surgeon can treat a problem inside the brain, then closes it again.
It treats tumors, bleeding, blood vessel problems, infections, injuries, seizures and pressure in the brain.
You will not feel pain during surgery. Some people are briefly woken up so the team can protect speech, movement or vision.
Surgery often takes three to five hours. Most people stay in hospital for several days, sometimes up to a week.
Full recovery can take several weeks to a few months. Long-term side effects are rare.
Craniotomy at a glance
Question | Short answer |
What is removed? | A section of skull (bone flap), put back at the end |
Why is it done? | Tumors, brain bleeds, blood vessel problems, infections, injuries, seizures, brain swelling |
Will I feel pain? | No — you receive anesthesia; the brain itself cannot feel pain |
How long does surgery take? | Usually 3–5 hours |
Hospital stay | Several days, sometimes up to a week, often starting in the ICU |
Recovery time | Several weeks to a few months |
Long-term side effects | Rare; depend on where in the brain the surgery happens |
What is a craniotomy?
A craniotomy is a type of brain surgery where a surgeon removes a section of your skull, called a bone flap, to reach your brain.
This opening lets the surgeon treat brain tumors, blood vessel problems, infections or injuries.
Special tools are used to make the opening. After the problem is treated, the bone flap goes back in place. It is usually held with small plates and screws.
A craniotomy is common and often safe, but it is major surgery and carries risks. Your care team will explain them and how they work to lower them.
What conditions does a craniotomy treat?
A craniotomy treats problems inside the skull that need direct access to the brain. These include:
Condition | Examples |
Brain tumors | Meningioma, glioma (including glioblastoma), cancer that has spread to the brain |
Bleeding and blood vessel problems | Brain bleed, brain aneurysm, damaged blood vessels |
Head and skull injuries | Skull fractures, brain injury after trauma |
Brain infections | Abscesses |
Seizure disorders | |
Nerve-related conditions | Microvascular decompression |
Pressure in the brain | Swelling or raised pressure |
What are the types of craniotomy?
Craniotomy types are usually named after the part of the skull where the opening is made.
Type | Where the opening is made |
Frontal | Front of the head, near the forehead and hairline |
Temporal | Side of the head, near the eye and just in front of the ear |
Parietal | Upper part of the head, toward the top and back |
Pterional (frontotemporal) | Side of the head, slightly above and in front of the ear, where the forehead meets the side of the head |
Orbitozygomatic | Near the eye socket and upper cheek |
Suboccipital | Lower back of the head, just above the neck |
Supraorbital | Right above the eyebrow |
Retrosigmoid | Right behind the ear |
What craniotomy techniques do surgeons use?
Craniotomy techniques describe how the surgery is done, not where. Your surgeon may mention one or more of these:
Technique | What it means |
Traditional | You are fully asleep under general anesthesia for the whole operation |
Awake | You are briefly woken to talk or move, so the team can protect important brain functions, then put back to sleep |
Endoscopic | A thin tool with a small camera goes through a very small opening in the skull |
Keyhole | Only a small opening is planned, which may mean a smaller cut and shorter recovery |
Stereotactic / navigation | MRI or CT images guide the surgery with high accuracy |
What is an awake craniotomy, and does it hurt?
An awake craniotomy is surgery where you are woken for part of the operation so the surgeon can check how your brain is working.
It is most common when surgery is near areas that control movement, speech or vision.
It does not hurt. The brain itself cannot feel pain, and your care team gives you medicine to keep you comfortable and calm.
How should you prepare for a craniotomy?
Preparing for a craniotomy starts with a meeting with your surgeon, who plans the operation and checks your overall health.
Your care team will run tests to make sure surgery is safe for you. They will also plan your care during and after the procedure.
Your surgeon may ask you to:
Arrive on surgery day with an empty stomach
Stop certain medicines, such as blood thinners, several days before
Take prescribed medicines before surgery, such as antibiotics, seizure medicine or steroids
Your surgeon will explain the procedure, possible side effects and healing time. Write down your questions and ask them — no question is too small.
What happens during a craniotomy?
A craniotomy begins with anesthesia, so you feel no pain. You are either asleep the whole time or woken for part of it.
Every craniotomy is different, but the main steps usually look like this:
Head positioning: Your head is carefully positioned and secured to keep you safe and avoid pressure points.
Incision area prep: A small patch of hair may be shaved. The skin is cleaned and the cut line is marked. Hair should grow back.
Making the opening: The surgeon cuts the scalp and moves muscle aside to reach the skull.
Removing a piece of skull: Small holes are drilled and a section of bone is removed and set aside.
Reaching the brain: The protective covering of the brain is opened over the treatment area.
Treating the problem: The planned procedure is done. This is usually the longest step, and a microscope may help with delicate work.
Closing the skull: The bone is put back and secured with small plates or screws.
Closing the incision: Tissue is moved back into place and the scalp is closed.
How long does a craniotomy take?
A craniotomy usually takes three to five hours, but this varies from person to person.
Your provider will give you a time estimate before surgery so you and your family know what to expect.
What are the benefits of a craniotomy?
The main benefit of a craniotomy is treating the problem that is causing your symptoms. Depending on your situation, it may:
Remove a brain tumor or blood from a bleed
Repair damaged blood vessels, bone or brain tissue
Treat a serious brain condition
In many cases, a craniotomy may prevent life-threatening outcomes and improve long-term health.
What are the risks of a craniotomy?
The risks of a craniotomy come from it being a major operation on the brain. Possible risks include:
Risk | What it means |
Bleeding | Blood loss during or after surgery |
A clot forming in a blood vessel | |
Brain swelling | Swelling of brain tissue after surgery |
Fluid around the brain leaking from the surgical area | |
Headaches | Head pain during recovery |
Infection | Infection of the wound or deeper tissue |
Pain or discomfort | Soreness at the incision site |
Seizures | Abnormal electrical activity in the brain |
Loss of blood flow to part of the brain | |
Coma | A deep state of unconsciousness |
Your surgeon will go through these risks with you and explain how your care team works to prevent them.
What are the long-term side effects of a craniotomy?
Long-term side effects of a craniotomy are rare and usually depend on where in the brain the surgery took place. They may include:
Behavior or personality changes
Visible scarring
Difficulty walking or moving
Balance or coordination problems
Trouble speaking or saying words clearly
What happens after a craniotomy in the hospital?
Recovery after a craniotomy starts in hospital and happens in stages. You may spend a short time in the ICU before moving to a regular room.
Close monitoring: Your team checks your brain function, blood pressure and breathing.
Pain and comfort care: You receive medicine for pain and rest.
Preventing complications: You may get medicine to prevent seizures, blood clots or infection. Fluid and electrolyte levels are watched.
Getting up and moving: When safe, you will sit, stand and walk with help. Moving early may lower the risk of blood clots and lung problems.
Eating and drinking: You slowly return to fluids and then food.
Follow-up imaging: Scans may check healing and confirm the surgery worked as planned.
Supportive therapies: Physical, speech or rehabilitation specialists may help with strength, movement, speech or daily tasks.
Going home: Before discharge, you get instructions on rest, activity, wound care and follow-up visits.
How long is craniotomy recovery?
Craniotomy recovery usually takes several weeks and can take a few months, depending on the reason for surgery and your overall health.
Stage | Typical timing | What happens |
Right after surgery | Short ICU stay, if needed | Close monitoring, pain control |
Hospital stay | Several days, sometimes up to a week | Medicines to prevent complications, walking, eating, scans |
Rehabilitation | As needed | Physical, speech or rehab therapy |
Home recovery | Several weeks to a few months | Rest, wound care, follow-up visits |
Your care team will tell you when it is safe to return to work, school and daily activities. Avoid heavy lifting and hard physical activity until your provider says it is safe. Call your surgeon for fever, redness or fluid leaking from the incision, or a headache that keeps getting worse; call 911 for a seizure, new weakness or numbness, trouble speaking, confusion or a sudden severe headache.
What is life expectancy after a craniotomy?
Life expectancy after a craniotomy depends on the reason for the surgery, your overall health and how complex the procedure is.
Your surgeon will review the risks and expected outcomes for your case so you can make informed decisions about your care.
Conclusion
A craniotomy is a big step, and it is normal to feel worried. It gives your surgical team direct access to treat a tumor, relieve pressure, stop bleeding or repair something inside the brain.
Recovery comes in small steps — resting, walking, eating and slowly returning to daily life. Each stage is part of healing, and your care team will guide you through it.
Next step: Save or print this guide and bring it to your next neurosurgery appointment. Use the tables above to ask about your craniotomy type, technique, risks and expected recovery time. For more plain-language guides, explore the Diseases & Conditions section on Rinnit.com.
FAQ
Is a craniotomy major surgery?
Yes. A craniotomy is major brain surgery that removes and replaces a section of skull. It is common and often safe, but it carries risks such as bleeding, infection, seizures and stroke.
Will I be awake during a craniotomy?
Most people are fully asleep. In an awake craniotomy, you are woken briefly to talk or move so the team can protect speech, movement or vision, then put back to sleep. It does not hurt.
How long does a craniotomy take?
A craniotomy usually takes three to five hours. Your surgeon will give you a personal time estimate before the operation.
How long will I stay in the hospital after a craniotomy?
Most people stay several days, sometimes up to a week. You may spend a short time in the ICU first.
Do they put the skull bone back after a craniotomy?
Yes. The bone flap is put back at the end of surgery and is usually secured with small plates and screws.
Will my hair grow back after a craniotomy?
Yes. Only a small area is shaved if needed, and the hair should grow back after surgery.
How long does it take to recover from a craniotomy?
Recovery takes several weeks and can take a few months, depending on the reason for surgery and your overall health.
When can I go back to work after a craniotomy?
Your care team will tell you when it is safe to return to work or school. Until then, avoid heavy lifting and hard physical activity.
What are the long-term side effects of a craniotomy?
Long-term side effects are rare. They can include balance problems, speech difficulty, trouble walking, personality changes or scarring, depending on where the surgery was done.
Will I have a scar after a craniotomy?
Yes, a craniotomy leaves a scar on the scalp. It is usually placed where hair will grow back and cover it as it heals.
Related reading on Rinnit.com
Further reading (external)
References
Cleveland Clinic. Craniotomy: What It Is, Procedure, Types & Recovery. Cleveland Clinic. Last updated September 28, 2026. https://my.clevelandclinic.org/health/treatments/24902-craniotomy
Lee KS, Borbas B, Plaha P, et al. Incidence and risk factors of surgical site infection after cranial surgery for patients with brain tumors: a systematic review and meta-analysis. World Neurosurgery. 2024;185:e800-e819. PMID 38432506. https://doi.org/10.1016/j.wneu.2024.02.133
Bu LH, Zhang J, Lu JF, et al. Glioma surgery with awake language mapping versus generalized anesthesia: a systematic review. Neurosurgical Review. 2021;44(4):1997-2011. PMID 33089447. https://doi.org/10.1007/s10143-020-01418-9
Nowacka A, Śniegocki M, Atkins W, et al. Awake craniotomy versus general anesthesia for resection of high-grade gliomas: a systematic review and meta-analysis. Journal of Clinical Medicine. 2026;15(4):1431. PMID 41753119. https://doi.org/10.3390/jcm15041431
Rao D, Le RT, Fiester P, et al. An illustrative review of common modern craniotomies. Journal of Clinical Imaging Science. 2020;10:81. PMID 33408956. https://doi.org/10.25259/JCIS_176_2020
Tariq R, Aziz HF, Paracha S, et al. Intraoperative mapping and preservation of executive functions in awake craniotomy: a systematic review. Neurological Sciences. 2024;45(8):3723-3735. PMID 38520640. https://doi.org/10.1007/s10072-024-07475-y
American Society of Anesthesiologists. Brain Surgery. Made for This Moment. Medically reviewed June 28, 2024. https://madeforthismoment.asahq.org/preparing-for-surgery/procedures/brain-surgery/
Disclaimer
This article is for general education and does not replace advice from your doctor or neurosurgery team. If you notice new or worsening symptoms after surgery, contact your care team right away.
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