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A craniotomy is surgery to reach and remove a brain tumour through a small, temporary opening in the skull. This page explains what it involves, awake versus asleep surgery, and what recovery looks like — so you can decide with confidence.
A craniotomy is an operation to reach and remove a brain tumour. The surgeon makes an incision in the scalp, temporarily lifts out a small section of skull bone — called a bone flap — and gently opens the membrane lining the brain (the dura). This creates a window to see and remove the tumour. The word combines cranium (skull) and -otomy (to cut into).
The goal is maximal safe resection — removing as much tumour as possible without harming the parts of the brain that control speech, movement, memory and vision. When surgery is complete, the bone flap is put back and fixed in place with tiny titanium plates and screws, and the scalp is closed. Over time the bone heals as one piece. This is the most common type of brain tumour surgery.
For tumours that are too deep, too risky to remove, or where only a sample is needed first, a smaller procedure called a stereotactic biopsy may be done instead. Your neuro-oncology team and surgeon decide the right approach together, guided by your MRI. Learn more about the full pathway on our brain tumour treatment page, or explore the wider brain cancer and tumour hub.
The brain itself has no pain receptors. This is why an awake craniotomy is even possible — once the scalp, skull and dura are numbed, the brain can be operated on while the patient talks and moves. According to the European Association of Neuro-Oncology (EANO) and NCCN guidelines, the extent of safe tumour removal is one of the strongest factors linked to better outcomes in many gliomas — which is why surgeons work so carefully to protect function while removing as much tumour as they can.
Surgery is often the first step for an accessible brain tumour. A craniotomy can serve several purposes at once — and your team will explain which goals apply to you.
For many tumours that can be safely reached, the main aim is to take out as much of the growth as possible. For some benign tumours, complete removal can be curative. For others, reducing the tumour relieves pressure and improves how well later treatments work.
Imaging suggests what a tumour might be, but only tissue confirms it. Surgery provides a sample for histology (the exact tumour type and grade) and for molecular testing — markers such as IDH and MGMT that directly shape what treatment follows.
A tumour can raise pressure inside the skull, causing headaches, drowsiness or worsening symptoms. Removing or reducing it — sometimes alongside steroid medicine to control swelling — can ease these symptoms and protect brain function.
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Whether you want to understand what a craniotomy involves, weigh awake versus asleep surgery, or get a second opinion before consenting — CION's neuro-oncology team will walk this journey with you.
One of the first questions patients ask is whether they will be awake during surgery. Both approaches are safe and widely used; the right one depends on where the tumour sits in relation to areas controlling speech and movement.
| Asleep Craniotomy | Awake Craniotomy | |
|---|---|---|
| Anaesthesia | Full general anaesthesia throughout — you are unconscious the whole time | Sedated to open and close; gently woken while the tumour is removed |
| Best suited to | Tumours away from speech and movement areas | Tumours in or near "eloquent" brain (speech, language, movement) |
| What happens | Surgeon removes tumour guided by neuronavigation | You talk, name pictures or move a hand while the surgeon maps and protects those functions in real time |
| Main benefit | Comfortable, familiar, suitable for most locations | More complete removal near critical areas with less risk to function |
An awake craniotomy sounds alarming, but it is well tolerated with careful preparation and a skilled anaesthetic team. Because the brain feels no pain, patients are comfortable, and most are speaking and moving normally within hours. We explain the experience step by step on our dedicated awake craniotomy page.
Every operation is planned individually, but most craniotomies for a brain tumour follow the same broad sequence. Knowing what to expect can make the day feel far less frightening.
Recovery is a pathway, not a single moment. It depends on the tumour's type and location, how much was removed, and your general health. Here is the typical picture — your own team will give you a plan made for you.
Driving, work and exercise are resumed gradually on your team's advice. At CION we coordinate rehabilitation and supportive care so recovery never feels like something you have to manage alone. Speak to our team about what your recovery would look like.
Surgery is rarely the whole story. What comes next is decided by what the laboratory finds in the removed tissue — and this is where coordinated neuro-oncology care matters most.
The removed tissue is examined to confirm the exact tumour type and its WHO grade (Grade 1 to 4). Crucially, it is also tested for molecular markers such as IDH mutation and MGMT methylation. These are testing concepts, not drugs — but they strongly influence prognosis and which treatments are likely to help. CION arranges this testing as standard on tissue from malignant gliomas.
For higher-grade tumours, radiation therapy (delivered with precision techniques such as IMRT/IGRT) and systemic drug therapy — for example alkylating chemotherapy — often follow once the wound has healed, usually after a few weeks. CION delivers radiation and systemic therapy directly. Some specialist radiosurgery options (such as stereotactic radiosurgery) are arranged as part of coordinated specialist care.
Regular follow-up MRIs watch for any change. Steroid and seizure medicines, rehabilitation, and supportive care are continued as needed. Every plan is reviewed by a tumour board for every patient — decisions for healing, not billing.
The tissue removed during a craniotomy is used for far more than confirming the diagnosis. The 2021 World Health Organization classification of brain tumours is built largely on molecular markers — meaning the lab results from your surgery can change both the grade given and the treatment recommended. EANO guidance highlights that arranging IDH and MGMT testing at the time of surgery is a key step in planning modern care, which is why CION ensures it is done on the removed tissue.
An important point to understand: the craniotomy operation itself is performed by accredited neurosurgical partners that CION works with. CION's neuro-oncology team plans the case and delivers everything around the surgery — so you have one team guiding the whole journey rather than fragments of care.
You deserve a team that explains every step and stays with you. Call 18002028726 or book a free consultation to discuss your situation.
Brain surgery is a major decision, and asking for a second opinion is never a delay to good care — it helps you consent with confidence. It is especially worthwhile if:
CION offers a free written second opinion. Explore related topics — brain tumour surgery, awake craniotomy, and the full brain tumour treatment pathway — or return to the brain cancer and tumour hub.
Get a free written second opinion from CION's neuro-oncology tumour board — especially valuable if awake craniotomy or molecular testing hasn't yet been discussed.
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Start Your Story. Book Free Consultation.A craniotomy is an operation where a surgeon temporarily removes a small section of the skull bone to reach a brain tumour, removes as much of the tumour as is safe, and then replaces the bone and closes the scalp. The word comes from cranium (skull) and -otomy (to cut into). It is the most common surgery used to take out a brain tumour. The bone piece is usually fixed back in place with tiny titanium plates and screws, so the skull heals as one piece. Most patients are surprised to learn the brain itself feels no pain — there are no pain nerves inside brain tissue.
In an asleep craniotomy you are under full general anaesthesia for the whole operation — the standard approach for tumours that are not close to areas controlling speech or movement. In an awake craniotomy you are sedated while the skull is opened, then gently woken so you can talk, name pictures, or move a hand while the surgeon maps and protects those critical areas in real time. You are sedated again to close. Awake surgery is chosen specifically when a tumour sits in or near "eloquent" brain — it lets the team remove more tumour safely. Read more on our awake craniotomy page.
No — the brain itself has no pain receptors, which is why an awake craniotomy is possible at all. The scalp, skull and the membrane lining (dura) do have sensation, so these are numbed with local anaesthetic and, for asleep surgery, you are fully unconscious throughout. After surgery, headache and scalp soreness are common for a few days and are managed well with medication. The team also manages nausea, swelling and seizure risk around the operation. Most patients describe the recovery discomfort as far milder than they feared.
Recovery varies with tumour type, location and your general health. Most people spend the first night in an ICU or close-monitoring unit and stay in hospital for around 3 to 7 days. Many return to light daily activities within a few weeks. If the tumour was near speech or movement areas, speech therapy, physiotherapy or cognitive rehabilitation may be part of recovery. Wound care, gradual return to activity and a follow-up MRI are all planned for you. Recovery is a pathway, not a single event — CION coordinates rehabilitation and supportive care so you are never left to manage it alone.
The neurosurgical operation itself — the craniotomy — is performed by accredited neurosurgical partners that CION coordinates with. CION's neuro-oncology team plans the case, arranges the imaging and biopsy, ensures molecular testing (IDH, MGMT) is done on the removed tissue, and delivers everything that follows surgery: radiation therapy, systemic medical therapy, steroid and seizure management, and rehabilitation. In other words, CION manages the whole journey around your surgery and works hand-in-hand with the neurosurgical partner who operates. This is why a single coordinated team — a tumour board for every patient — matters so much.
The removed tissue is sent for histology (what type of tumour) and molecular testing (markers such as IDH mutation and MGMT methylation) that guide the next steps. Based on the WHO grade and these markers, your neuro-oncology team decides whether radiation therapy, systemic drug therapy, or close monitoring is needed. For high-grade gliomas, radiation and chemotherapy usually begin a few weeks after surgery once the wound has healed. A follow-up MRI confirms how much tumour was removed. Every plan is reviewed by a multidisciplinary tumour board before it is finalised.
A second opinion is especially worthwhile before brain surgery in three situations: if the tumour sits in or near speech or movement areas and awake craniotomy has not been discussed; if molecular testing (IDH, MGMT) has not been planned on the tissue that will be removed; and if you simply want to understand the goals, risks and alternatives of surgery clearly before consenting. CION offers a free written second opinion reviewing your MRI and reports. Asking is never a delay to care — it helps you make a confident, informed decision about your own treatment.
Disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified oncologist or neurosurgeon for guidance specific to your condition. This page is periodically reviewed and updated by CION's medical team in line with current clinical guidelines, including those of NCCN and EANO.
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