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 Bombay.
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 stationmaster, 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’s like he’s 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’s 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’s 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.
45 thoughts on “The skull”
One question. If a small similar growth on forehead, which is stable in size for years, does it need to be removed?
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Hi Doc,
Are we slowly getting to know of your culinary skills as well?
Thank you for the well writ article.
Enjoyed this
Every Sunday eagerly waiting to read your post
All are very interesting increasing my medical knowledge and learning a lot medical and non medical
You are multitalented Dr
I admire and respect you a lot
All my patient are successfully treatment with 100 percent good results
Stay Blessed Always
Eagerly waiting for your POST , & enjoy to Read Every Sunday
Very skilful Job 👌👏👏
Thanks for sharing 🙏
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A succinct lecture about the skull, which has really helped ne appreciate the skull and it’s importance to the human body and surgery. The submission written in simple non- surgical language for full comprehension. Dr Mazda, you remain unmatched.
Ralecha Kopano MMATLI Botswana
You are great Dr. Mazda…
Very re-assuring to start to learn about the skull from you. Many thanks.
U r a Sunday habit … delightful
After seventy years of living and being a student of science too, I learnt new things today. Thank you Mazda, for the umpteenth time.
Bless you!
You gave Aakash back his forehead, and his wife, her favourite view of him. Trust you to turn neurosurgery into heritage restoration. Complete with balconies, facades, and zero complaints from the housing society.
But it would probably grow again in 5 years? Also, I’m wondering if there was this protuberance on the outside, may it not also be on the inside of the skull and put pressure on the brain. Or was that already clarified through scans.
I am a non-medical person and seek your indulgence on what may seem an irrelevant question.
I worked as a hotel cleaner, struggling to survive and provide for my family. The pay was often not enough for our bills, and sometimes I felt like giving up, but my sister kept encouraging me. One Wednesday at about 2:30pm, a guest came to the hotel celebrating a huge Powerball win. He shared his testimony about how Lord Bubuza, a spell caster, had helped him win by revealing the lottery numbers he played after casting a lottery spell. His story gave me hope, so I contacted Lord Bubuza on WhatsApp: +1 (365) 808 5313 for help. I provided the requirements to cast the lottery spell and he gave me the Powerball winning numbers. I bought a $2 ticket and played. When I checked my ticket, I could hardly believe my eyes. I had won $639,000,000. After years of suffering, I broke down in tears. I am deeply grateful to Lord Bubuza. My story reminds me that even after years of hardship, life can change unexpectedly. Never give up hope, lord Bubuza is a God on Earth and can help you too. Contact him via
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Mazda..enjoyed this thoroughly..u truly r a master of the simile and metaphor and of description..don’t stop writing or operating ever…
Dear doctor,this write up reminds me of my own skull being opened by ur skilled hands some 8 years back for a major brain surgery. Every time i go thru my scalp during a head massage or cleaning ,i can feel a zig zag line across my scalp.God forbid,but i really pray to my God that any one with any kind of brain problem reaches u.
Hi Mazda
Your today’s piece shows that u hv complete mastery over the human skull.
The finesse with which u performed this surgery using the various tools is simply awesome.
Dr Mazda your articles are impressive, worth reading as you share your knowledge and lessen the surgery fear phobia. Always waiting to read more.
Dr. Mazda,,
I remember you from when you worked for a very short time in Toronto Western hospital atleast a decade or more ago.
I will always remember your knowledge and kindness shown towards my husband Dinshaw for a spine issue.
I remember you sitting and chatting with him. My heartfelt thanks to you.
Continue the good work you are doing. God bless
Have been reading and lapping up all that you have been writing.
Your style and knowledge is a boon to people like me who are not doctors but intrigued by the brain and body anatomy. Thanks for your work.
Dear Mazda
An interesting and informative article. The more i read your articles the more I hold the brain in awe
Looking forward go the next article
Yayyy!! A neuro can b an architect too!!!
Virtually visited his skull without an invitation! Well done n amazingly well written.. AS ALWAYS!
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