Craniotomy Classification [Neurosurgery Wiki]

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====== Craniotomy Classification ======

Craniotomies can be classified based on anatomical location, surgical approach, indication, and technical considerations.

===== 1. By Anatomical Location =====
^ Region              ^ Common Indications                                    ^
| **[[Frontal craniotomy]]**         | Tumors, trauma, abscess, epilepsy, frontal sinus      |
| **Temporal**        | Epilepsy surgery, mesial temporal sclerosis, tumors   |
| **Parietal**        | Tumors, AVMs, metastases, cortical mapping            |
| **Occipital**       | Tumors, AVMs, visual cortex lesions                   |
| **Pterional**       | Aneurysms, skull base tumors, MCA/ICA lesions         |
| **Subtemporal**     | Petroclival tumors, mesial temporal lobe access       |
| **Orbitozygomatic** | Skull base lesions, aneurysms, craniopharyngiomas     |
| **Retrosigmoid**    | Acoustic neuromas, posterior fossa tumors             |
| **Suboccipital**    | Chiari malformation, posterior fossa tumors           |
| **Transpetrosal**   | Clival and petroclival pathology                      |

===== 2. By Surgical Approach =====
^ Approach Type          ^ Description                                           ^
| **Standard craniotomy**| Bone flap removed and replaced after surgery         |
| **Keyhole craniotomy** | Minimally invasive, small access (e.g., eyebrow)     |
| **Extended approaches**| Combined or large exposures (e.g., OZ + pterional)   |
| **Endoscopic-assisted**| With or without bone flap, skull base procedures     |
| **Awake craniotomy**   | Functional mapping in conscious patients             |

===== 3. By Indication =====
^ Indication              ^ Example Craniotomies                                ^
| **Tumor**               | Frontal, parietal, pterional, suboccipital          |
| **Vascular**            | Pterional, orbitozygomatic, occipital, parasagittal |
| **Epilepsy**            | Temporal lobectomy, frontal lobe resection          |
| **Trauma**              | Decompressive hemicraniectomy, bifrontal            |
| **Infection/Abscess**   | Frontal, parietal                                   |
| **Chiari Malformation** | Suboccipital midline decompression                  |

===== 4. By Technical Features =====
^ Type                         ^ Characteristics                                  ^
| **Decompressive craniectomy**| Bone not replaced; used in severe trauma/stroke |
| **Craniotomy with duraplasty**| Dural expansion using graft                    |
| **Burr hole craniotomy**     | For hematomas or catheter insertion (e.g., EVD) |


  * Standard [[craniotomy]]
  * Keyhole craniotomy
  * Awake craniotomy
  * Extended bifrontal craniotomy
  * Pterional (frontotemporal) craniotomy
  * Retrosigmoid craniotomy
  * Suboccipital craniotomy

  * Orbitozygomatic craniotomy