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In a craniotomy, the procedure involves the surgical removal of a bone flap of the skull to access the brain. This technique is vital for various medical interventions, including tumor removal, treatment of traumatic brain injuries, or addressing other neurological issues. The removal of the bone flap allows surgeons to gain direct access to the brain while maintaining the integrity of the surrounding structures.

While a layer of scalp may also be incised to reach the skull, it is not the primary structure removed to access the brain; instead, it is more of a preparatory step. Similarly, soft tissue around the brain is typically manipulated rather than removed, and the spine is not involved in a craniotomy, as this is focused solely on the cranial area. By understanding that the craniotomy specifically refers to the removal of a portion of the skull, one can appreciate the precise nature of the surgical intervention aimed at treating conditions affecting the brain.