Standard Craniotomy
A standard craniotomy is the foundational neurosurgical procedure used to access the brain for a wide range of cranial conditions. Performed under general anaesthesia, the surgeon makes a incision in the scalp and carefully removes a section of the skull bone (bone flap) to expose the brain beneath. Once the target condition — such as a tumour, aneurysm, or blood clot — is treated, the bone flap is securely replaced and fastened with specialized micro-plates and screws.
When this procedure may be recommended
- Brain tumours (meningiomas, gliomas, metastases) requiring surgical removal.
- Cerebral aneurysms or arteriovenous malformations (AVMs) requiring surgical clipping or repair.
- Intracranial haemorrhage (subdural, extradural, or intracerebral hematomas) requiring urgent decompression.
- Chiari malformation requiring suboccipital decompression.
Who may be a candidate
Recommended for patients with structural brain lesions or bleeding that require direct, open surgical access and cannot be treated safely or effectively via minimally invasive endovascular routes or radiosurgery alone.
Advanced medical implant technology (no text). Alternatives to surgery
- Stereotactic biopsy (if only a tissue diagnosis is needed).
- Stereotactic radiosurgery (Gamma Knife) for small, deep tumours or AVMs.
- Endovascular coiling or embolisation for aneurysms and vascular lesions.
- Conservative monitoring with sequential imaging.
What to expect
- Anaesthesia & Rig: The patient is placed under general anaesthesia and their head is secured in a three-pin skull clamp to prevent any movement.
- Scalp Incision: The scalp is prepared, and an incision is made, hidden behind the hairline wherever possible.
- Bone Window: A specialized surgical drill (craniotome) is used to cut a window in the skull, and the bone flap is carefully lifted and stored.
- Dural Opening: The protective outer membrane of the brain (dura mater) is cut and folded back, exposing the brain tissue.
- Target Treatment: The surgeon utilizes high-magnification microscopes to remove the tumour, clip the aneurysm, or drain the hematoma.
- Bone Reattachment: The dura is sutured closed, the bone flap is replaced and secured with titanium plates and screws, and the scalp is closed.
Technology and imaging
Employs 3D electromagnetic or optical neuronavigation (cranial GPS), high-performance neurosurgical microscopes, ultrasonic tissue aspirators, and intraoperative Doppler ultrasound.
High-precision diagnostic imaging visualization. 
Clinical Zeiss/Leica operating microscope setup. Hospital stay
Usually 3 to 5 nights in hospital, beginning with an overnight stay in the ICU or HDU.
Recovery milestones
- Day 1: Continuous neurological checks in the ICU. Pain and nausea are managed.
- Days 2-4: Transfer to the ward, progressive mobilising, and removal of wound drains/dressings.
- Weeks 1-6: Physical rest at home. Expect mild headaches, localized scalp numbness, and fatigue. No heavy lifting, driving, or swimming.
- Week 6+: Clinical review with the surgeon. Return to light duties.
Post-operative mobilization and recovery milestones. Risks and complications
- Bleeding or blood clot formation (hematoma) requiring return to theatre (1% to 2% risk).
- Stroke, weakness, numbness, speech difficulties, or visual disturbance.
- Infection of the bone flap or meningitis (1% to 3% risk).
- Seizures (often managed prophylactically with anti-epileptic medications).
Frequently asked questions
How is the bone flap held in place after surgery?
The bone flap is reattached using tiny, highly biocompatible titanium micro-plates and screws. Over time, the natural bone heals and fuses back together, just like a broken bone.
Will my hair be completely shaved?
No. Dr Aliashkevich uses modern surgical techniques where only a very narrow strip of hair along the incision line is shaved. Most incisions are hidden behind the hairline.