Reconstruction of cranial deficit is achieved by the classic surgery of cranioplasty.
The most common reason behind a cranial deficit is the iatrogenic cause, that is the intended removal of a part of the skull by the neurosurgeon (decompressive craniectomy) in order to save the patient’s life and neurological condition after severe cerebral injuries that are accompanied by high intracranial pressure. Patients surviving such injuries are subject to cranioplasty after some time has passed (up to six months if an infection has occurred) when it is safe for them.
Cranial deficit may also be caused by compressive skull fractures after a head injury as well as by congenital reasons (e.g., meningoceles). Large cranial deficits are usually accompanied by a cerebrospinal fluid circulation disorder, manifested with headaches, dizziness, delay in the neurological recovery, and so on.
Moreover, patients feel down and less confident because of the deformity. For this reason, plastic and reconstructive surgery is recommended to be performed as soon as possible. This way, the likelihood of an injury in the exposed part of the brain is also decreased while patients with severe mobility disorders recover.
Materials used in these operations are advanced nowadays and they consist of either a titanium plate or a simple polymethylmethacrylate (PMMA) or even a completely customized implant that will exactly fit the cranial deficit or a biological material that gradually turns to bone. These implants are adapted to the cranial deficit and are stabilized with the assistance of special forceps made by titanium or biodegradable plastic (Craniofix, miniplates, etc.).
The patient is monitored postoperatively for wound or materials contamination and is administered intravenous antibiotics as a prevention measure. Sutures are removed after the tenth postoperative day in order to prevent surgical wound dehiscence. A rare complication of cranioplasty is transplant rejection by the host’s immune system.