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Cranioplasty

What Is A Cranioplasty?

Cranioplasty refers to a reconstructive procedure performed to repair cranial defects (holes in the skull). These procedures are performed to repair and reconstruct defects caused by previous surgeries or traumas.

Types Of Cranioplasty

Cranioplasties may vary depending on the type of material used to reconstruct the skull defect. The first cranioplasty was thought to have been performed more than 4000 years ago, using precious metals and shells. Fortunately today, advancements have been made in the type of materials used. Titanium implants are both non-reactive and moldable that serves as a temporary or permanent reconstruction. Other materials include synthetic bone substitutes, as well as acrylic implants.

How Do You Prepare For A Cranioplasty?

The goal of the surgery is to restore the natural contour and shape of the skull, in addition to providing a rigid protective structure around the brain. In essence, the cranioplasty is performed to replace the rigid bony structure that is missing in the skull. The cranioplasty can be prepared prior to the surgery. These are known as “prefabricated” implants. These implants can be designed and 3D printed to provide excellent results. Once completed, they are sterilized and utilized during the operation. Other times, cranioplasties can be prepared at the time of surgery. These non-prefabricated implants are hand contoured by the surgeon during the surgery. Sometimes, temporary, non-prefabricated implants are used, allowing for time to develop and print a 3D printed cranioplasty that can be placed at a secondary operation.

Why Is A Cranioplasty Performed?

Defects of the skull may occur after surgery or related to cancer resections or prior craniotomies. Other times, patients may have defects secondary to prior traumas. Cranioplasties are performed to fill these defects, restore the shape and contour of the skull, while providing a protective encasement around the brain.

What Can You Expect During A Cranioplasty?

Depending on the reason for your cranioplasty, the recovery may be different. Generally speaking, cranioplasties are typically performed under anesthesia either as a stand-alone procedure or in combination with other surgeries. After the cranioplasty, you should expect to spend at least 2 days in the hospital to monitor your post-operative healing, in addition to managing pain. More extensive surgery may require longer hospital stays. Cranioplasties are performed through incisions in the scalp. It is not uncommon to experience numbness around the incision. Additionally, patients may experience mild and temporary hair loss around the incision.

What Is The Followup And Recovery Like For A Cranioplasty?

Recovery after a cranioplasty may vary depending on the indication for the surgery. The immediate recovery period is typically spent in the hospital where you will be cared for around the clock by trained providers including nurses and doctors. They will manage pain while ensuring that you are healing well from the surgery. During this time, it is normal to experience mild pain and discomfort around the incisions. Patients can typically resume their normal diet. During the immediate postoperative period, it is normal to have drains in the scalp to remove any fluids that may collect. These are usually removed prior to discharge, but it is not uncommon to go home with them. Upon discharge from the hospital, you will return home with restricted activities. Your first week, you will need to minimize any heavy lifting or strenuous activities. Your doctor may prescribe stool softeners to prevent any bearing down. Other medications typically include pain medications and antibiotics. You will likely follow up with your physician within 1 to 2 weeks of discharge.

What Are The Potential Costs For A Cranioplasty?

Cranioplasty costs are typically covered by insurance, as these are deemed necessary procedures.

What Are The Potential Risks For A Cranioplasty?

  • Infection. Depending on the material used, the indication for surgery, and associated patient comorbidities, patients may develop an infection in or around the site of the reconstruction. If this occurs, patients may require antibiotics (either oral or administered through an IV), or in some circumstances removal of the infected implant. Precautions are typically taken during and after surgery to prevent the development of an infection.
  • Bleeding. Although rare, patients may have bleeding at or around the site of cranioplasty.
    Stroke. Depending on the indication for surgery, patients may develop bleeding or clots in the brain that may cause stroke. This is uncommon, and usually relates to the intracranial portion of the surgery, and not necessarily the reconstructive portion.
  • CSF Leak. Although uncommon, patients may develop leakage of brain fluid at or around the site of surgery. These can be managed conservatively, resolve on their own, or require subsequent surgeries.
  • Anesthesia. Any procedure performed under anesthesia carries risks of reaction to the anesthetic administered and may not be related to the cranioplasty reconstruction.
  • Numbness. It is not uncommon to develop numbness at the incision sites. This typically improves over 6 months, but in some circumstances may be permanent.
  • Facial Nerve Paralysis. Although rare, cranioplasties carry the risk of weakness in facial movement after surgery. This is usually temporary, but in rare circumstances may be permanent.
  • Fluid Collection. Sometimes, patients may develop collection of blood or bodily fluids at the site of cranioplasty. This is usually prevented by placement of drains that are usually removed prior to discharge from the hospital.
  • Complications of Related Surgery. Cranioplasty is typically performed in addition to other surgery (e.g. tumor resection). It is important to understand the inherent risks to all aspects of your surgery.

Are There Other Related Procedures To A Cranioplasty?

Cranioplasty may be performed in addition to other types of surgery. Other related surgeries include neurosurgical procedures such as tumor removal, clot evacuation, cranial decompression, or trauma-related repairs. Other surgeries may involve surgery on the nose and sinuses. Sometimes, patients may have associated flap procedures.

What Makes You The Right Doctor For A Cranioplasty?

Dr. Mourad is a double board certified surgeon with advanced training in reconstructive surgery of the skull. He has extensive experience and is a leader in the field of skull base and cranioplasty related procedures. He has published more than 33 peer reviewed articles, in addition to a textbook. Dr. Mourad is an assistant professor at New York Medical College, faculty at Lenox Hill Hospital, and the Chief of Head & Neck Surgery for TJH Health Services.

Meet Dr. Moustafa Mourad, MD, FACS

Moustafa Mourad, MD, FACS is board-certified in head and neck surgery and highly-trained in cosmetic plastic surgery and facial reconstruction. Dr. Mourad is also a Fellow of the American College of Surgeons. He treats many conditions, both cosmetic and complex, that affect the head, neck and entire facial area. Learn More »

Kadakia S, Badhey A, Inman J, Mourad M, and Ducic Y. Surgical management of temporal bone osteoradionecrosis: Single surgeon experience of 47 cases. American Journal of Otolaryngology. 2017 Nov-Dec; 38(6):688-91. Link to Article.

Mofiyinfolu Sokoya, Mourad M, and Ducic Y. Complications of Skull Base Surgery. Semin Plast Surg. 2017 Nov; 31(4): 227–230. Link to Article.

Mofiyinfolu Sokoya, Arash Bahrami, Jason Cohn, Sameep Kadakia, Moustafa Mourad, Yadranko Ducic. Orbital Skull Base Reconstruction with Temporalis Muscle: The Sphenoid Keyhole Technique. CMTR Open. 2018; 02(01): e27-e30. Link to Article.

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