Craniotomy (brain surgery)
An operation that temporarily opens part of the skull so a neurosurgeon can reach the brain — for example to remove a tumour, stop bleeding, or treat a blood-vessel problem.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A craniotomy temporarily opens the skull so the surgeon can operate on the brain, then replaces the bone.
- The risks and benefits depend heavily on the underlying condition, its size and where it is in the brain.
- Serious risks are real — including bleeding, infection, stroke-like problems, seizures and, rarely, death — and must be weighed against the risk of not operating.
- Recovery varies from days to months, decisions are usually made by a specialist team, and there are often important driving and lifestyle implications afterwards.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can remove or reduce a brain tumour and provide tissue for an exact diagnosis
The problem can be managed more safely another way, such as monitoring, medicines, radiotherapy or a smaller biopsy.
You are watched closely, sometimes in intensive care or a high-dependency unit at first. Headache and tiredness are common. Many people are in hospital...
Close monitoring after surgery with clear written warning signs and an urgent contact route.
You are watched closely, sometimes in intensive care or a high-dependency unit at first. Headache and tiredness...
Wound heals and swelling settles. You build up rest and gentle activity. Energy and concentration return...
Most people continue to improve over this time. The wound bruising fades to a thin pale line over three to six...
Some effects may continue to improve for months, and a few may be lasting. Driving may be restricted for a period...
What is a craniotomy?
A craniotomy is an operation in which a neurosurgeon temporarily removes a small window of bone from the skull to reach the brain, then replaces the bone at the end. It is the standard way to operate on the brain itself.
It is done for many different and often serious reasons: to remove or take a sample (biopsy) of a brain tumour, to stop or prevent bleeding, to treat a weakened blood vessel (aneurysm) or abnormal tangle of vessels, to relieve pressure on the brain, to treat severe epilepsy, or after a head injury. Because the reasons are so different, what a craniotomy involves — and how risky it is — depends heavily on the underlying problem, its size and where it sits in the brain.
The most important thing to understand is that a craniotomy is major surgery on the most delicate organ in the body. For some conditions it can be life-saving or greatly improve symptoms; for others it carries serious risks and is one option among several. The right decision depends entirely on your diagnosis, and is usually made with a specialist team (a multidisciplinary team) rather than by one person alone.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Craniotomy versus other approaches (where there is a choice)
| Craniotomy | Other options | |
|---|---|---|
| What it does | Direct access to the brain | Less or no opening of the skull |
| Examples of alternatives | — | Biopsy, keyhole, radiotherapy, watch and wait |
| When chosen | Removal or repair needed | Smaller problem or higher surgical risk |
| Recovery | Often longer | Often shorter |
| Decision | Made with a specialist team | Made with a specialist team |
Whether a craniotomy is the best option depends entirely on the diagnosis. For some conditions there is no good alternative; for others, biopsy, radiotherapy, medicines or monitoring may be considered. A specialist team should explain the choices.
Preparing for your surgery
- Ask the team to explain your exact diagnosis, why a craniotomy is recommended, and what the alternatives and the risks of not operating are.
- Expect detailed brain scans before surgery, and sometimes extra tests to map important areas of the brain.
- Tell the team about all medicines, especially blood thinners and anti-seizure medicines, and any allergies.
- Discuss whether part of the operation may be done awake, and what that involves.
- Arrange support at home and time off, as recovery can take weeks to months depending on the reason.
- Talk through what the operation may and may not change about your symptoms.
- Ask about driving rules afterwards, as these are often affected, especially if you have seizures.
What happens
Most craniotomies are done under general anaesthetic, so you are asleep, although some are done partly awake when the area being operated on controls speech or movement. A small amount of hair is shaved and a cut is made in the scalp. The surgeon removes a window of skull bone, opens the lining over the brain, and carries out the operation — for example removing a tumour or treating a blood vessel — using a microscope and, often, computer guidance.
The bone is then put back and fixed in place, and the scalp is closed. A craniotomy often takes around four to six hours but can take significantly longer depending on the problem. Afterwards you are usually looked after closely, sometimes in intensive care or a high-dependency unit, before moving to a ward.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- The problem can be managed more safely another way, such as monitoring, medicines, radiotherapy or a smaller biopsy.
- The risks of operating near critical brain areas outweigh the likely benefit for your condition.
- Your general health makes major surgery and anaesthetic too dangerous.
- Surgery would not change the outlook for your specific diagnosis.
Delay surgery if…
- There is an active infection or another treatable problem that should be sorted first (where the situation is not an emergency).
- You are on blood thinners that need safe planning before surgery.
- Further scans or tests are needed to plan safely.
- Your condition is stable and a period of monitoring is reasonable.
Alternatives to discuss
- Watchful waiting with monitoring scans for some conditions.
- Biopsy alone to get a diagnosis before deciding on treatment.
- Keyhole or endoscopic approaches in selected cases.
- Radiotherapy, including stereotactic radiosurgery, for some tumours or vessel problems.
- Medicines, such as anti-seizure or steroid treatment, depending on the condition.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Can remove or reduce a brain tumour and provide tissue for an exact diagnosis
- Can relieve dangerous pressure on the brain
- Can stop or prevent bleeding, or treat a weakened blood vessel
- Can be life-saving in some emergencies
- Can improve symptoms or seizures for carefully selected conditions
Risks & complications
- Headache, tiredness and a strange or numb feeling around the wound for some weeks
- Swelling and bruising around the eye and scalp that settles over weeks
- Needing time to regain energy, concentration and confidence
- Infection of the wound, bone or brain, sometimes needing antibiotics or further surgery
- A leak of brain fluid (CSF) from the wound or nose
- Seizures (fits), which may mean taking anti-seizure medicine and not driving for a time
- A blood clot in the leg or lung
- Bleeding inside the head after surgery, sometimes needing another operation
- Stroke-like problems such as weakness, numbness, or difficulty with speech, vision or swallowing, which may be temporary or lasting
- Serious complications that can be life-threatening; death is uncommon but possible
The biggest point is that the level of risk depends heavily on your specific condition, its size and where it is in the brain — surgery near areas controlling speech or movement carries more risk to those functions. The risk of having surgery must always be weighed against the risk of not having it. Ask your surgeon to be specific about your own risks and what the realistic goal of the operation is.
Published figures to discuss
Risk varies enormously with the underlying condition, its size and position, and your general health. The figures below come from NHS patient information for craniotomy and brain-tumour removal and are a guide only; surgery near areas controlling speech or movement carries higher risk to those functions. Your surgeon should give you numbers for your specific operation.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Bleeding inside the head after surgery | Around 4 in 100 in NHS brain-tumour craniotomy information | May need another operation; from a UK NHS patient leaflet. | NHS (Cambridge University Hospitals) — Craniotomy and resection of brain tumour in adultscuh.nhs.ukSource-linked context |
| Infection (brain or wound) | Roughly 1 to 5 in 100 for brain infection and around 2 in 100 for surface wound infection in NHS information | May need antibiotics or further surgery. | NHS (Cambridge University Hospitals) — Craniotomy and resection of brain tumour in adultscuh.nhs.ukSource-linked context |
| Brain fluid (CSF) leak | Roughly 1 to 5 in 100 in NHS information | May settle or may need treatment. | NHS (Cambridge University Hospitals) — Craniotomy and resection of brain tumour in adultscuh.nhs.ukSource-linked context |
| Stroke-like neurological problem | Around 3 in 100 when away from critical areas, rising to around 10 in 100 when near areas controlling speech or movement, in NHS information | May be temporary or lasting; depends on location. | NHS (Cambridge University Hospitals) — Craniotomy and resection of brain tumour in adultscuh.nhs.ukSource-linked context |
| Death | Around 1 in 100 in NHS brain-tumour craniotomy information | Varies greatly with the condition and urgency; weighed against the risk of not operating. | NHS (Cambridge University Hospitals) — Craniotomy and resection of brain tumour in adultscuh.nhs.ukPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery after a craniotomy varies widely with the reason for surgery and how you were beforehand. Early recovery focuses on careful monitoring and rest; longer-term recovery may involve rehabilitation and gradually rebuilding energy and confidence over weeks to months.
- Headache, tiredness and reduced concentration in the early weeks
- Swelling and bruising around the eye and scalp that settles
- A strange, numb or tight feeling around the wound for some weeks
- Emotional ups and downs, which are common after major brain surgery
Aftercare
- Follow wound-care advice closely and keep the area clean and dry.
- Take any anti-seizure or other medicines exactly as prescribed and do not stop them suddenly.
- Rest plenty at first and build up activity gradually as advised.
- Do not drive until your team confirms it is allowed and you have checked the rules with the driving authority — the DVLA in England, Scotland and Wales, or the DVA in Northern Ireland. Driving is often restricted after brain surgery or seizures.
- Attend any rehabilitation (physiotherapy, speech or occupational therapy) arranged for you.
- Avoid contact sports and flying until your team says it is safe.
- Keep all follow-up appointments, including any to discuss further treatment.
- Have someone with you in the early days and know who to contact with concerns.
- Someone to stay with you in the first days at home
- All medicines, including anti-seizure medicines, collected and understood
- A list of warning signs and an emergency contact number
- Time off work and help with childcare or caring arranged
- Transport sorted, knowing you may not be able to drive
- Follow-up and any further-treatment appointments noted
- Questions written down for your follow-up
Scars and how they heal
A craniotomy leaves a scar on the scalp, usually hidden within the hairline where possible. The bruising and swelling fade to a thin pale line over three to six months, and hair usually grows back over the scar. There may be a small area of numbness around it.
⚠ Get urgent help if…
- A severe or worsening headache not helped by your usual painkillers
- Drowsiness, confusion, or being difficult to wake
- New weakness, numbness, or problems with speech, vision or swallowing
- A seizure (fit)
- Clear fluid leaking from the wound or nose (possible brain-fluid leak)
- Increasing redness, swelling, heat or discharge from the wound, or a high temperature
- Repeated vomiting, a stiff neck, or sensitivity to light
- Calf pain or swelling, or sudden breathlessness or chest pain (possible blood clot)
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
What a good result looks like depends entirely on why the operation was done. For a tumour, it may mean removing as much as was safe and getting an exact diagnosis to guide further treatment; for bleeding or an aneurysm, it may mean relieving pressure or preventing further bleeds. The lab analysis of any tissue removed is an important part of the result and can take a couple of weeks.
A craniotomy cannot promise to cure the underlying condition or remove every trace of a tumour, and it cannot guarantee that symptoms will fully resolve. The realistic goal is set with your specialist team and depends on your diagnosis, so it is important to understand what this particular operation is trying to achieve for you.
How lasting the benefit is depends on the condition treated. For some problems a craniotomy provides a permanent solution; for others, such as certain tumours, further treatment, monitoring scans or even repeat surgery may be needed over time. Your team will explain the likely outlook for your specific diagnosis and how you will be followed up.
Combining with other procedures
A craniotomy is often part of a wider plan rather than a stand-alone treatment. For tumours, it may be followed by radiotherapy, chemotherapy or targeted treatment depending on the lab results. Detailed scans and tests are usually done beforehand, and rehabilitation may follow. Decisions are normally made by a multidisciplinary team.
Follow-up & long-term care
You will be followed up by your neurosurgery and, where relevant, oncology team, often with scans to monitor the area and discuss the results of any tissue removed. Rehabilitation may continue after discharge. Any warning signs — especially severe headache, drowsiness, seizures, new weakness or a fluid leak — should prompt urgent contact rather than waiting for an appointment.
- Take anti-seizure or other medicines exactly as prescribed and attend medication reviews.
- Attend follow-up scans and appointments to monitor your condition.
- Follow the driving rules set by the DVLA (in England, Scotland and Wales) or the DVA (in Northern Ireland), which may apply for a set period after surgery or seizures.
- Continue any rehabilitation exercises or therapy as advised.
- Report new symptoms early rather than waiting.
Revision and secondary surgery reality
- For some tumours, not all can be safely removed, and further surgery or other treatment may be needed.
- Bleeding or other complications can occasionally require an urgent return to theatre.
- Monitoring scans may show regrowth or a new problem needing further treatment over time.
- Some neurological effects improve with rehabilitation, while a few may be lasting.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Close monitoring after surgery with clear written warning signs and an urgent contact route.
- A named team and planned follow-up, including discussion of any pathology results.
- Access to rehabilitation such as physiotherapy, speech and occupational therapy.
- Clear advice on medicines, driving and return to daily life.
- A coordinated plan for any further treatment, with support for you and your family.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Brain surgery is overwhelmingly an NHS service, so private cost questions arise rarely
- Where private care applies: the neurosurgeon's and anaesthetist's fees
- The complexity, length and urgency of the operation
- Intensive care or high-dependency time afterwards
- Imaging, computer guidance and laboratory analysis of any tissue removed
- Rehabilitation (physiotherapy, speech or occupational therapy)
- Any further treatment such as radiotherapy or chemotherapy
- The named neurosurgeon's fee and the anaesthetist's fee
- The hospital fee, including any intensive care or high-dependency stay
- Imaging and laboratory (pathology) costs
- Rehabilitation included afterwards
- What happens, and who pays, if a complication or readmission occurs
- How further treatment (radiotherapy, chemotherapy) would be arranged and funded
- Cancellation and rescheduling terms
On the NHS? Craniotomy is almost always carried out on the NHS in specialist centres, often urgently; private brain surgery is uncommon, though people may seek a private second opinion.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told the realistic goal of surgery (for example, that not all of a tumour may be removable).
- No clear discussion of alternatives such as biopsy, radiotherapy or monitoring.
- Risks near critical brain areas not being clearly explained.
- No discussion of driving rules and the need to inform the DVLA (in England, Scotland and Wales) or the DVA (in Northern Ireland).
- Decisions made without involving a multidisciplinary specialist team.
Marketing red flags
- Any promise to completely cure a brain tumour or remove it with no risk.
- Claims that a particular technique is without risks or guarantees a normal recovery.
- Pressure to proceed privately without a multidisciplinary team opinion.
- Downplaying serious risks such as stroke, seizures or death.
- No honest discussion of the alternatives or the chance of needing further treatment.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- What exactly is my diagnosis, and why is a craniotomy recommended for me?
- What is the realistic goal of the operation, and what are the alternatives or the risks of not operating?
- What are my specific risks given the size and position of the problem in my brain?
- Will part of the operation be done awake, and what will that involve?
- What further treatment might I need depending on the results, and how will I be followed up?
- What will the rules be for driving, work and daily life afterwards?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will a craniotomy cure my condition?
Is it done on the NHS or privately?
What does an awake craniotomy involve?
Will I be able to drive afterwards?
How long is the recovery?
How risky is brain surgery?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS (Cambridge University Hospitals) — Craniotomy and resection of brain tumour in adults NHS (Cambridge University Hospitals) — Seizures following craniotomy NHS (UCLH) — Having a craniotomy or biopsy for a suspected brain tumour Brain & Spine Foundation — Brain surgery GIRFT — Cranial neurosurgery (national standards) GOV.UK / DVLA — Driving and brain conditions and surgery DVLA — Assessing fitness to drive (medical guidance) DVA (Northern Ireland) — Telling DVA about a driver medical condition
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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