Craniotomy vs. Craniectomy

The Difference Between a Craniotomy and a Craniectomy

Brain surgeon wearing medical head light helmet, close-up
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Brain surgery is a very serious procedure, and if you or someone you love has been told brain surgery is necessary you must have many questions.  Many brain surgeries start with opening the top of the skull to provide an opening through which the surgeon can work, although there are a few that are done through a small opening at the back of the nose. 

The Craniotomy Procedure

A craniotomy is a surgery during which a piece of the skull (a bone flap) is removed in order to allow a surgeon access to the brain.

After the surgery is performed, the bone flap is returned to its previous location, where it can heal and mend like any broken bone. In many cases, metal plates are used to hold the bone flap in place so that it can heal, much like a cast for a broken arm.

The Craniectomy Procedure

A craniectomy procedure also includes the removal of a bone flap, but in this case, it is not returned to its location after the procedure is finished. This may be due to trauma to the bone itself, because the brain is too swollen to permit the return of the bone flap, or because the surgeon feels it is in the patient’s best interest. If there is an infection in the area, for example, the bone flap may be discarded.

The Bone Flap

If a bone flap is removed, but not able to be returned during the procedure, it can still be put back into place at a later time. In this situation, the surgeon will place the bone flap in another location.

In most cases, the surgeon will place the flap in the abdomen, under the fatty tissue, where it is protected and preserved by the patient’s own body.  Bone flaps can also be placed in a special deep freezer for storage until it can be replaced.

If the bone flap cannot be returned, prosthetics and artificial bone are also available to aid the reconstruction at a later date.


Bone Flap Management In Neurosurgery. Rev Neurocienc 2008. Accessed January 2010.