====== 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