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Craniotomy for Excision of a Cerebral Arteriovenous Malformation


A craniotomy is surgery to open your skull and operate on your brain. You may need a craniotomy if you have an arteriovenous malformation (AVM). An AVM is an abnormal connection between the arteries and veins in your brain. An AVM may be found anywhere in your brain. You may need a craniotomy if your AVM causes your brain to bleed. You may also need a craniotomy if you have symptoms such as seizures, headaches, or speech problems.


Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  • Blood tests: You may need blood taken to give healthcare providers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  • Embolization therapy: Your healthcare provider may put a substance into the arteries that lead to your AVM. This will block the arteries and stop blood from flowing into your AVM. If your AVM is large, embolization therapy may make its center smaller.
  • Tests:
    • Angiography: This test is used to check the blood flow in your brain.
    • CT scan: This is also called CAT scan. An x-ray machine uses a computer to take pictures of your bones, brain tissue, and blood vessels. It may show the location of your AVM. It may also show if your blood vessels are bleeding or becoming hard.
    • MRI: An MRI makes an image of your brain and the abnormal blood vessels of your AVM. During the MRI, you may also have a test called magnetic resonance angiography, or MRA. An MRA may be done to see the blood flow inside your AVM. This will help your healthcare provider see if your blood vessels have areas that are blocked or narrow.
  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  • Pre-op care: You may be given medicine to make you feel relaxed and sleepy right before your surgery. You are taken on a stretcher to the room where your surgery will be done.
    • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
    • Monitoring:
      • Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show healthcare providers how well your brain works after an injury or illness. A provider will check how your pupils (black dots in the center of each eye) react to light. He or she may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.
      • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
      • A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine.

During your surgery:

  • An incision is made to open your scalp. Your healthcare provider carefully drills your skull to make an opening. He then removes a piece of your skull so he can see your brain and AVM. He clips or ties the arteries to stop the blood flow to your AVM.
  • Your healthcare provider may inject a substance to block the arteries. This plugs up the arteries so blood cannot flow into your AVM. Your healthcare provider then removes the cluster of abnormal blood vessels from your AVM. He ties the vein that was attached to the AVM. He makes sure there are no areas that are bleeding inside your brain. Your skull bone is put back in place and the incision is closed with stitches. Your healthcare provider then covers your stitches with bandages.

After your surgery:

You will be taken to a room where you will rest until you wake up. Healthcare providers will watch you closely for any problems. Your breathing, blood pressure, and pulse will be checked often. When healthcare providers see that you are okay, you will be taken back to your hospital room. Do not get out of bed until your healthcare provider says it is okay. A healthcare provider may remove your bandages soon after surgery to check your wound.

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  • Vital signs: Healthcare providers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. Vital signs give information about your current health.
  • Medicines:
    • Anticonvulsants: This medicine controls seizures.
    • Antihypertensives: Antihypertensives decrease the pressure in your brain by lowering your blood pressure.
    • Antinausea medicine: This medicine calms your stomach. General anesthesia can cause nausea and vomiting. Nausea and vomiting may cause your brain to bleed because the pressure inside is increased.
    • Barbiturates: This medicine may be used to keep you asleep. You may need to be kept asleep if you have too much pressure in your brain.
    • Steroids: Steroids decrease swelling in your brain.
    • Blood thinners help prevent blood clots. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise.
  • Tests: After your craniotomy, your healthcare provider will do tests to make certain that your AVM was completely removed. Angiography may show if there are still abnormal vessels in your brain. Your healthcare provider may also do a CT scan of your brain to check for bleeding.


  • You may get an infection. You may have headaches, eyesight problems, or seizures. You may be allergic to the medicine used during your surgery, or you may bleed more than expected. Your brain and the layers of tissue that cover it may swell. You may need surgery again if some of the abnormal blood vessels were not removed. You may get a blood clot in your leg or arm. The blood clot can break loose and travel to your lungs or brain. Your AVM may also hemorrhage (bleed heavily) in your brain. If there is bleeding or a blood clot in your brain, you may have a stroke. These problems can be life-threatening.
  • If you do not have a craniotomy, your AVM may rupture and bleed. You may die if your bleeding continues. Call your healthcare provider if you have questions or concerns about your surgery, condition, or care.


You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment.

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