The skull is a fortress: smooth on the outside, intricate on the inside. It’s a piece of architecture where renovation work happens with the owner still living within. It houses the brain with a precision no civil engineer could match—22 bones locked together like a jigsaw puzzle, with joints called sutures that have more personality than most house committees in south Mumbai.
It’s easy to forget about your skull. You don’t see it, you don’t feel it, and it doesn’t ask for attention—unless something goes wrong. For Aakash, a retired railway station master, something definitely had. He came in with a slow-growing bump on his forehead, the size of a small lime. His wife, who spoke more than he did, explained, “It started small, but now it’s all I see when I look at him. It is like he is wearing a little hill.”
I examined it. It was firm, bony, and painless. The skin was normal. This wasn’t a cyst or swelling in the scalp. This was the skull itself, expanding from within. A CT scan confirmed an osteoma, a benign bony growth—the architectural equivalent of an unnecessary balcony jutting out from an otherwise perfect facade. It wasn’t dangerous, but it was becoming socially awkward. “People have started asking if I bumped my head and forgot about it,” he said.
Operating on the skull feels different from other surgeries. There’s no soft give, no gentle tissue to separate… it is all about precision, patience and power tools. We began with a curved incision just behind the bump, careful to hide it within a natural skin crease. Once through the scalp layers, the bony surface gleamed under the operating lights. The osteoma stood out clearly—a white, solid dome fused with the skull, as immovable as an old landlord.
Removing it meant drilling it down flush with the surrounding bone. I picked up the high-speed craniotome—the surgical equivalent of a dentist’s drill but with the horsepower of a carpenter’s drill. The first contact made that familiar high-pitched whir, sending a fine spray of bone dust into the suction tip. The key here is control: too little pressure and nothing happens; too much, and you could breach the bone’s inner table, which is dangerously close to the dura and brain. It is like grating coconut—you want the right layer, not the shell beneath.
Bit by bit, the dome flattened. The smell of warm bone—faintly like burnt popcorn—filled the air. Once level, we smoothed the edges with a diamond burr until the contour matched perfectly with the rest of his forehead. Bleeding from bone is steady but manageable. A little bone wax sealed the channels, and we closed the wound in layers. When the dressing went on, the hill was gone.
The next morning, Aakash looked in the mirror and grinned. “I look like myself again!” His wife nodded approvingly. “Now I can take his photograph without photoshopping out the bump,” she laughed.
The skull doesn’t get the everyday attention the brain does, but it’s more than just a helmet. It’s the stage on which neurosurgery begins—every burr hole, every craniotomy, starts with negotiating the thickness, curvature, and quirks of the skull. Sometimes, we open it to reach the brain. Other times, as with Aakash, the skull itself is the problem and the solution is about restoration, not exploration.
It’s easy to think of surgery as only the dramatic stuff—removing tumours, clipping aneurysms—but there’s a quiet satisfaction in simply restoring the smooth curve of someone’s forehead, giving them back the face they remember. The skull may be rigid, but in the right hands, it allows a little architectural improvement. And unlike most building projects in Mumbai, you can finish it in under an hour with no complaints from the residents.
The author is consultant neurosurgeon at Wockhardt Hospital, Mumbai.
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