Cranial Reconstruction and Neuroplastic Surgery

Defects will sometimes be deliberately left following emergency neurosurgery. The repair of such defects serves to improve cosmetic appearance as well as to provide protection to the exposed brain. Occasionally corrective surgery may be desirable to improve appearances as a result of bone flap shrinkage following craniotomy or to address the consequences of infection.

Frequently Asked Questions

When is surgery required for skull defects?

Surgery is typically indicated when a skull defect compromises the protection of the brain, causes significant neurological symptoms, or results in unacceptable cosmetic deformity. Each case is evaluated individually to determine the safest timing and technique. It will sometimes bein indicated simultaneously with removal of a tumour of the skull vault.

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What is neuroplastic surgery?

Neuroplastic surgery combines neurosurgical precision with plastic surgery techniques to address complex scalp and cranial wounds. This often involves specialized tissue flaps or grafts to ensure proper healing of the skin and underlying structures after complex cranial procedures and may draw expertise from several specialisms.

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What is a Cranioplasty?

Cranial reconstruction or Cranioplasty is a surgical procedure designed to repair defects in the skull, whether caused by traumatic injury, previous surgery, or congenital conditions. The goal is to restore structural integrity, protect the underlying brain tissue, and achieve a satisfactory cosmetic outcome.

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Cranioplasty

Repair of a defect in the cranial vault is termed cranioplasty. Autologous cranioplasty utilises a persons one bone that may have been stored following the initial procedure. Bone flaps stored under the skin or externally can shrink meaning the cosmetic result is poor and the margins of the bony door may be visible. This is usually only an issue with craniotomies on the cranial convexities and defects in the sub-occipital bone, over the cerebellum, are well covered by the thick muscles of the neck. Autologous cranioplasty may also be associated with an elevated risk of infection after implantation.

Repair of a defect in the cranial vault is termed cranioplasty. Autologous cranioplasty utilises a persons one bone that may have been stored following the initial procedure. Bone flaps stored under the skin or externally can shrink meaning the cosmetic result is poor and the margins of the bony door may be visible. This is usually only an issue with craniotomies on the cranial convexities and defects in the sub-occipital bone, over the cerebellum, are well covered by the thick muscles of the neck. Autologous cranioplasty may also be associated with an elevated risk of infection after implantation.

Decompressive craniectomy is a procedure where a large door is raised in the cranial vault to allow an injured brain to swell with pressing on adjacent uninjured brain. It is usually carried out as an emergency in order to save life. The commonest indications are follwoing traumatic brain injury or after a large stroke (Malignant middle cerebral artery stroke). Occasionally a defect in the cranium result from having to remove infected bone or a piece of bone which has been involved by a tumour. The image above is constructed from a CT scan and shows there has been a hemicraniectomy awaiting reconstruction.

A 3D printed plated designed on a template created from CT imaging of the skull defect can provide a perfect reconstruction and excellent cosmetic result. The materials we currently favour produce very little distortion on MR imaging subsequently and minimise the redundant space beneath the plate where blood may collect. It is possible to create complex plates to reconstruct the bones of the skull and the facial skeleton.

Syndrome of the Trephined

A rare consequences of any sizeable defect in the cranial vault is the development of motor impairment, cognitive and/or language disability that is directly related to the presence of the defect and imports when it is repaired. While probably underdiagnosed it is likely with earlier repair of a defect and is most associated with large craniectomies as shown above. It may result from the altered transcranial pressure and is frequently characterised by a very sunken wound.