Cranial Reconstruction Surgery or Cranioplasty

What is it?

Neurosurgeons operate on the brain through openings in the skull, or they remove tumours involving the skull bone itself. When an operation is completed, large openings are closed, usually by replacing the bone that was originally there. Patients suffering trauma to the skull may have the fractured areas of the skull removed permanently. More recently, patients suffering a closed head injury can undergo a "decompressive craniectomy" to relieve presurre on the brain by removing a large portion of skull bone. Often this bone is not returned to the patient's head due to infection risk.

Small openings (less than 1cm or about 1/2 inch) are often left open. These smaller openings sometimes heal, but whether they do or do not, they generally do not cause a problem for the patient.

Sometimes a large opening cannot be repaired or covered during the initial operation. Reasons for this include brain swelling, infection, and tumour. In these patients, a skull defect persists. Other patients suffer a skull defect when the bone flap from a previous craniotomy surgery needs to be removed and discarded due to infection. Decompressive Craniectomy patients in particular may be left with a large skull defect after recovery from their trauma.

Some patients choose to live with the defect, others opt for reconstruction via a cranioplasty procedure. Traditionally this is achieved by shaping arcylic paste or thin titanium mesh onto the skull defect directly during an operation. With the advent of high-resolution CT scanning, computer modelling and BioModelling technology, precise custom implants which are an exact fit and give an excellent cosmetic result can be manufactured in advance of surgery. Not only do such prefabricated implants allow a superior reconstruction over traditional methods, they also allow for a reduction in operating time.

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