1. Preparation of operating areaIn the image above, a sterile covering is applied to the operating area, and the skin is prepared so that blood loss will be minimised.
This is done by injecting a special solution that will constrict blood vessels and minimise blood loss. It consists of a saline solution mixed with adrenaline and local anaesthetic to constrict blood vessels under the skin, and reduce blood loss and post-operative pain.
2. Preparing for a craniotomySurgeon Cesnulis installs a brain retractor, a tool made from soft, flexible metal. When inserted, this gently pulls the brain a little away from the area of surgery.
Then, the first skin incision is made and the surgeon double checks where the skull should be drilled with the help of neuronavigation: here, Cesnulis comments that "it‘s important to use every possible centimetre of the craniotomy area, in order to have access to the deeply seated tumour."
The bone is then drilled into with a skull perforator, an automatic mechanical tool that works on compressed air. It stops automatically as soon as the inner layer of the skull is perforated, in order to not injure the brain.
3. The craniotomyFirst, the surgeon prepares the bore holes and dissects the dura mater away from the bone, so there is a corridor to go in with the craniotomy instruments.
The craniotomy is performed on the left, so the tumour can be reached on the opposite side. During this procedure, the tip of the drill is protected with a special shoe to protect the dura mater and the brain.
Holding sutures are placed on the dura, in order to prevent blood gathering between the skull and dura after surgery. This is called epidural haematoma and would cause serious damage to the brain.