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Vascular malformations of the brain
A guide for patients and carers
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Neurosurgery (craniotomy)
Neurosurgery is surgery on the brain or spine. Surgery to open the head and operate on the brain is called a craniotomy. Craniotomy is the longest established treatment for vascular malformations of the brain. It is usually used to treat AVMs of the brain, and sometimes AVFs of the dura, by disconnecting the AVM from the arteries that supply it with blood and the veins that drain it. Craniotomy is sometimes also used to remove cavernous malformations.
The decision to go ahead with a craniotomy will be based on the particular risks associated with your condition and how safe it is to operate on your vascular malformation, depending on its size and exact location.
You will be admitted to hospital the day before your surgery is scheduled. Usually, your fitness for a general anaesthetic will have been assessed with a thorough examination, blood tests, and possibly a recording of your heart rhythm. You will not be allowed to eat for six hours or drink for two hours before the operation. An anaesthetist will give you a general anaesthetic on the day of your surgery so you will be asleep before you are taken into the operating theatre.
The team of health professionals looking after you will include one or more neurosurgeons, an anaesthetist, and theatre nurses. An area of your hair is shaved over the point at which the vascular malformation can be reached. An incision (cut) is made in the scalp, a skin flap is peeled back, burr holes are drilled in the skull, and a piece of bone (‘bone flap’) is cut out like a trapdoor to reveal the brain and vascular malformation underneath. An AVM will then be carefully detached from the surrounding blood vessels. This can take several hours.
The bone flap is replaced and the scalp is stitched together. The bone flap is usually fixed into place with small metal screws to prevent movement and encourage better healing. You will be taken to a recovery area, usually in the intensive care unit, where you will be under close observation. Shortly after you have woken up from the anaesthetic, you will be transferred back to the ward. You can expect to leave the hospital within a week or ten days, if you are not experiencing any problems.
After the surgery, you might experience epileptic seizures for the first time. If you have already had them, they might improve or worsen. Some weeks or months after the operation, your doctors will want to repeat an angiogram or MRI scan to see how effective the surgery has been. You will need to convalesce at home for a few weeks and some people require physiotherapy in a rehabilitation unit. It is likely that you will need to take several weeks off work after the operation. Some people need to take several months off.
As with any treatment, there are risks and benefits with a craniotomy. It might be possible to remove your vascular malformation completely and this could protect you from developing other associated problems in the future. Surgery is sometimes used to remove larger vascular malformations that are too big for radiosurgery and could only be partially treated with embolisation. However, surgery requires a general anaesthetic which has its own risks and some vascular malformations deep in the brain cannot be reached safely with a craniotomy. Surgery to remove a vascular malformation carries a risk of stroke as a result of the procedure.
(You might like to read our fact sheet on craniotomy for further information.)
What happens before a craniotomy?
You will be admitted to hospital the day before your surgery is scheduled. Usually, your fitness for a general anaesthetic will have been assessed with a thorough examination, blood tests, and possibly a recording of your heart rhythm. You will not be allowed to eat for six hours or drink for two hours before the operation. An anaesthetist will give you a general anaesthetic on the day of your surgery so you will be asleep before you are taken into the operating theatre.
What happens during a craniotomy?
The team of health professionals looking after you will include one or more neurosurgeons, an anaesthetist, and theatre nurses. An area of your hair is shaved over the point at which the vascular malformation can be reached. An incision (cut) is made in the scalp, a skin flap is peeled back, burr holes are drilled in the skull, and a piece of bone (‘bone flap’) is cut out like a trapdoor to reveal the brain and vascular malformation underneath. An AVM will then be carefully detached from the surrounding blood vessels. This can take several hours.
What happens after a craniotomy?
The bone flap is replaced and the scalp is stitched together. The bone flap is usually fixed into place with small metal screws to prevent movement and encourage better healing. You will be taken to a recovery area, usually in the intensive care unit, where you will be under close observation. Shortly after you have woken up from the anaesthetic, you will be transferred back to the ward. You can expect to leave the hospital within a week or ten days, if you are not experiencing any problems.
After the surgery, you might experience epileptic seizures for the first time. If you have already had them, they might improve or worsen. Some weeks or months after the operation, your doctors will want to repeat an angiogram or MRI scan to see how effective the surgery has been. You will need to convalesce at home for a few weeks and some people require physiotherapy in a rehabilitation unit. It is likely that you will need to take several weeks off work after the operation. Some people need to take several months off.
As with any treatment, there are risks and benefits with a craniotomy. It might be possible to remove your vascular malformation completely and this could protect you from developing other associated problems in the future. Surgery is sometimes used to remove larger vascular malformations that are too big for radiosurgery and could only be partially treated with embolisation. However, surgery requires a general anaesthetic which has its own risks and some vascular malformations deep in the brain cannot be reached safely with a craniotomy. Surgery to remove a vascular malformation carries a risk of stroke as a result of the procedure.
(You might like to read our fact sheet on craniotomy for further information.)
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Contents
- What are vascular malformations of the brain?
- Arteriovenous malformations (AVMs)
- Cavernous malformations (cavernomas)
- Developmental venous anomalies (venous malformations)
- Moyamoya disease
- Common questions about vascular malformations of the brain
- Symptoms of vascular malformations of the brain
- Tests and investigations for vascular malformations of the brain
- Possible treatments for vascular malformations of the brain
- Embolisation
- Stereotactic radiosurgery
- Neurosurgery (craniotomy)
- Other treatments for vascular malformations of the brain
- Everyday activities
- Research into vascular malformations of the brain
- Health professionals working with vascular malformations of the brain
- Useful contacts, support groups and further reading
- Thank you
- Your feedback on Vascular malformations of the brain
