During a craniotomy, what is the next step after the removal of the bone flap?

After the removal of the bone flap during a craniotomy, the next step is to incise the dura mater. This is a critical step in exposing the underlying brain tissue for surgical intervention. The dura mater is a tough membrane that encases the brain and spinal cord; accessing it is essential for any further procedures that may be needed, such as tumor resection or hematoma evacuation.

Opening the galea aponeurotica occurs earlier in the procedure when establishing the scalp incision and reflects the soft tissue before the skull is approached. The application of Raney clips is typically used to secure the dura or control bleeding once the incision is made. Repairing the dura mater would happen after the surgical procedure is completed, when the dural closure is necessary to ensure the protection of the brain and maintain the integrity of the cranial cavity. Hence, incising the dura mater is the immediate logical step following the bone flap removal.