How Is Brain Surgery Actually Performed? Inside a Craniotomy

One of the questions I get asked most, often by a patient’s spouse or grown child the night before surgery, is some version of: “But how do you actually get to the brain?”

It’s a fair question. The skull isn’t a door you knock on. To reach a tumour, a bleed, or damaged tissue inside, the first step is always the same: a craniotomy — carefully opening a section of the skull to expose the brain beneath.

In this video, I walk through a real case and show exactly how that’s done.

What the video covers

• Why a craniotomy is the first step in most brain tumour and brain injury operations
• How the bone flap is planned and removed to expose the operative field
• What happens to the skull afterward — the bone is replaced and secured, not discarded
• How we protect healthy brain tissue while working toward the area that needs treatment

Why I share cases like this

Brain surgery sounds frightening in the abstract. Most of that fear comes from not knowing what’s actually happening behind the drapes. I’ve found that patients and families who understand the mechanics — what’s being cut, what’s being protected, what happens step by step — carry far less anxiety into the operating theatre than those who don’t.

This is a real operative demonstration, shared for educational purposes. If you or a family member are facing a diagnosis that may require this kind of surgery, know that the goal at every stage is precision: reach what needs to be treated, and protect everything around it.

Frequently asked questions

What is a craniotomy? A craniotomy is a surgical procedure in which a section of the skull, called a bone flap, is temporarily removed to allow a neurosurgeon direct access to the brain. Once the operation underneath — such as removing a tumour, clipping an aneurysm, or evacuating a bleed — is complete, the bone flap is replaced and secured with plates and screws.

Is a craniotomy dangerous? Every brain operation carries risk, but a craniotomy performed by an experienced neurosurgical team is a controlled, precise procedure, not an improvised one. Risks are minimised through careful pre-operative imaging and planning, intraoperative navigation, and techniques that protect healthy brain tissue while reaching the area that needs treatment.

How long does it take to recover from a craniotomy? Most patients stay in hospital for several days to a week after a craniotomy, depending on the underlying condition and how the surgery went. Full recovery — including return to normal activity — typically takes several weeks to a few months, and is guided by the neurosurgical team based on the individual’s progress.

Does the bone removed during a craniotomy get put back? Yes. The bone flap is set aside during the operation and then replaced and secured with titanium plates and screws once the procedure is complete. This is different from a craniectomy, where the bone is deliberately left out, usually to manage brain swelling, and replaced later or reconstructed with an implant.

What conditions require a craniotomy? A craniotomy is the standard first step for most operations that need direct access to the brain, including removal of brain tumours, clipping or coiling of aneurysms, evacuation of intracranial haemorrhage, treatment of arteriovenous malformations, and management of severe traumatic brain injury.

Book a consultation

If this video raised questions about your own diagnosis or a loved one’s, Dr Nor Faizal’s team is here to help.

Book an appointment at KPJ Tawakkal Specialist Hospital, Kuala Lumpur.