Cranioplasty

What is Cranioplasty?

The surgical correction of a bone deficiency in the skull caused by an injury or prior procedure is known as cranioplasty. Although cranioplasties come in a variety of forms, the most include lifting the scalp and using the original skull piece or a customized graft made up of materials like

Mesh or plate of titanium
Liquid replacement for synthetic bone.
Solid biomaterial (a prefabricated, specially designed implant that precisely fits the shape and contour of the skull).

By performing a cranioplasty, doctors can fix or restructure a portion of the skull. A cranioplasty may be required to treat irregularities in the skull or following a traumatic brain injury. A cranioplasty could involve remodeling the skull, restoring trauma-induced damage to the skull, or replacing a portion of the skull that was removed during a prior treatment.

A cranioplasty can enhance physical function and psychological well-being, maintain the integrity of the skull, and protect the brain.

Why would a doctor suggest a cranioplasty?

Any of the following factors could lead to a cranioplasty:

Protection: The brain may be sensitive to harm in certain areas due to a cranial defect.
Function: For certain patients, cranioplasty may enhance neurological function. In certain cases, a customised cranial implant is pre-designed to contain integrated neuro technology and assist the surgeon in achieving the desired form and result. A significant skull abnormalities may impact a patient’s confidence and looks.
Headaches: Headaches caused on by prior surgery or trauma can be eased with cranioplasty.

For what circumstances is a cranioplasty necessary?

A cranioplasty may be necessary for the following conditions:

Injury brought on by severe/traumatic injury
Gaps or flaws brought on by earlier procedures
Congenital disorders of the skull
Infections that result in bone loss
Abnormalities in the shape of the skull
Radiation therapy-induced defects of the skull (osteoradionecrosis)
Severe osteoporosis
Paget’s condition

Expectations prior to a cranioplasty

In order to develop a treatment plan, a patient’s medical team must evaluate their condition and comprehend certain aspects of their health prior to any important procedure. Certain tests and examinations can be required for this.

These could consist of:

A physical examination and medical history
Testing for blood and urine
ECG & blood pressure readings
A neurological examination
Tests for kidney and liver function
CT scan, MRI, and X-ray

Prior to surgery, a patient will schedule sessions to talk about any medications they are taking and ask any questions they may have regarding the process.

Before cranioplasty, what information does doctor need to know?

Inform your physician if you:

Having any medical issues, such as blood-clotting disorders.
Use blood thinners such aspirin, warfarin, or anti-inflammatory medications.
Have any allergies to drugs or other things.

Tips for getting ready for a Cranioplasty

Prior to having a cranioplasty, a patient should talk to their medical team about how to get ready for the treatment and what to pack for the day of the procedure.

This could consist of:

Photo ID, health insurance card, cosy clothes, toiletries, any prescribed drugs,nutritious snacks and other comfort things.

Quitting smoking prior to surgery can help lower the risk of complications during and following the procedure. According to research quitting smoking for at least four weeks before to surgery may help improve results. Before surgery, a patient’s doctor can offer resources and support to help them cut back or quit smoking.

Prior to surgery, a patient is typically prohibited from eating or drinking for a specific amount of time. Patients must abide by the guidelines provided by their surgical team regarding when they should stop eating and drinking.

What is the process of a cranioplasty?

To ensure that the patient has no pain during the procedure a general anaesthetic is given in the operation room. A patient will often be sleeping during the procedure, though the exact type of anaesthesia used may vary from case to case. The team arranges you to provide the surgeons the best possible access to the bone defect while you’re unconscious. After shaving and cleaning the incision site with antiseptic, you are draped so that only the surgical site is visible.

After giving a local anaesthetic, the surgeon will carefully cut and gently remove the layers of skin on your scalp, protecting the dura, which surrounds the brain. The affected portion of the skull will be visible through an incision made in the scalp by the surgeon during the surgery. Each operation will have a different incision size and location. In order for the bone or implant to be positioned correctly in the defect, the team cleans the margins of the surrounding bone and prepares the surface. It then secures it to the cranial bones using screws, plates, or both. If there are any bone damage areas, the surgeon will remove them. The material used to rebuild the skull will then be positioned by the surgical team. The material for the new bone will be selected by the surgical team according to the individual’s needs and condition.

After securing the bone or implant and controlling the haemorrhage, the team returns the scalp to its initial position and uses nylon suture to seal the incision. Additionally, a tiny suction drain could be left in position to aid in the removal of any extra fluid. In a few days, the drain will be taken out.

The advantages of Cranioplasty

A person may benefit from a cranioplasty in a variety of ways. Sometimes the advantages involve improving their bodily health as well as psychological and social well-being.

Advantages consist of:

Safeguarding the brain
Improving speech and facial movement while restoring or changing one’s physical appearance
Enhancing mental health conditions and quality of life
Offering a permanent remedy for skull abnormalities

Cranioplasty’s Risks

Although a cranioplasty is usually a safe technique, problems are possible with any surgery. Infection (which may require antibiotic treatment), blood clot that needs to be drained after surgery. According to research, the major complication rate for a cranioplasty is between 10 and 40 percent.

Some possible issues are:

Infection
Bleeding implant failure or displacement
Seizures
Intracerebral haematoma (blood clot inside the skull)
Recurrence of haemorrhage due to neurological impairments
Responses to stroke and anaesthesia
Leakage of cerebral spinal fluid (CFS)
Stroke
Leg clot, which is rarely able to reach the lungs.
Complication that has nothing to do with the procedure itself
Pneumonia.
Heart attack.
Infection of the urine.

Before doing a cranioplasty, a surgeon will talk over the risks with the patient and take note of any risk factors they may have.

How does your recovery process following a cranioplasty go?

Aftercare could consist of:

Pain control
Wound care
Hydration and nutrition monitoring
Mental support

After an hour or so, patient will be moved to the neurosurgery floor or the neurosurgical critical care unit (NCCU) or intensive care unit (ICU) or recovery room after waking up in recovery. Nursing staff will test your blood pressure, pulse, limb strength, and level of consciousness while continuously keeping an eye out for any indications of a problem. Patients will be awakened for these observations on your first night in the hospital.

Although head surgeries rarely cause much pain, they might get a headache and will be given painkillers and injections to keep you comfortable. Because of the procedure, they can still have a urinary catheter in place.

Patient will be advised to walk after nurse removes the IV drip from their arm during the next day or so. They will eventually be able to move about normally. On the second day after surgery, their head wrap will be taken off.

After surgery, the majority of cranioplasty patients stay in the hospital for two to three days. Patients will receive a follow-up CT scan of your head once your care team has assessed your ability to move about, take a shower, and get dressed. They will be released and allowed to return home if the surgery site appears to be in good condition.

After the patient leaves the hospital, what happens?

It could take a while before they feel fully recovered.

They will be exhausted.
It’s normal to need a nap in the afternoon.
Might get frequent headaches.
After surgery, they will have appointments to have your sutures taken out one week and three to four weeks later.
Rehabilitation may be necessary, depending on how quickly they recover from any preoperative disabilities.

Get in touch with your surgical team RIGHT AWAY if you observe:

The headache is becoming worse.
Fever.
Seizures.
Infection or swelling in the wound.
Leakage of fluid from the wound.

Important: Until your doctor certifies that you are ready, DO NOT DRIVE. A week or two following your operation, you will be evaluated to see if you are fit to drive.

Healing and Hope

A hospital stay of a few days to a week is normal after a cranioplasty. It could take several months to fully heal.

After a cranioplasty, a patient needs to follow the advise of their healthcare staff and may not be able to engage in some of their regular activities during this period.

Activities that are restricted could include:

Driving, physical exertion, hard lifting, contact sports, and the use of tobacco and alcohol.

A person’s specific condition and risk factors, as well as the initial reason for the treatment, all impact the outlook after a cranioplasty. According to a 2019 study, cranioplasty significantly improved the quality of life for people with moderate or extensive cranial abnormalities after 24 months.

Conclusion

A surgeon may perform a cranioplasty to fix, rebuild, or restructure a portion of the skull. A cranioplasty can sometimes be necessary after a prior procedure in which a portion of the skull was removed by the surgeon.

A cranioplasty may be suggested by a surgeon to treat a variety of disorders which affect the structural strength of a person’s skull. Many people report improvements in their physical, social, and psychological well-being as well as an overall improvement in their quality of life after the procedure.