Cranioplasty
Cranioplasty is the surgical procedure used to repair a defect (gap) in the skull, with the aim of protecting the brain, restoring the normal shape of the head, and improving the patient’s neurological function.
This defect usually arises after a previous operation, such as tumour removal, treatment of trauma, or reduction of intracranial pressure, during which part of the skull was removed (craniectomy).
Cranioplasty is then performed at a later stage to “close” this opening using safe and biocompatible materials.
Why cranioplasty is important
Beyond cosmetic restoration, cranioplasty has important functional significance. When part of the skull is missing for a prolonged period, the brain is exposed to atmospheric pressure without the protection of bone.
This may lead to the so-called syndrome of the trephined (also called sinking skin flap syndrome) a condition that can present with:
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Headaches and dizziness
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Difficulty concentrating and cognitive disturbances
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Weakness or numbness in the limbs
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General deterioration in neurological status
Timely and properly planned cranioplasty helps restore normal cerebrospinal fluid flow and cerebral perfusion, contributing to improvement in these symptoms.
When the operation is performed
The timing of cranioplasty depends on the reason that led to removal of the bone:
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After trauma with brain swelling: the operation is usually delayed until the swelling has settled.
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After tumour removal: reconstruction is often carried out during the same operation or soon afterwards.
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After decompressive craniectomy (because of raised intracranial pressure): timing is individualised according to the patient’s neurological stability, while current trends suggest that earlier reconstruction may offer better outcomes without an increased risk of infection.
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In the case of previous infection: the operation is postponed until full control of the infection has been achieved.
The neurosurgeon assesses each case individually, taking into account the patient’s age, the size of the defect and their overall health status.
Materials used
The choice of material is individualised according to the size of the defect, the patient’s age and the particular features of each case.
Autologous bone (the patient’s own bone)
The section of skull that was originally removed is “stored” in the subcutaneous fat of the abdomen and, at a later stage, is used to cover the cranial defect.
Titanium
Lightweight, durable and associated with a very low infection rate. It is often used in larger defects, either alone or in combination with other materials for a better cosmetic result.
PEEK (polyether ether ketone)
A modern, lightweight material manufactured individually with great precision for each patient, without interfering with imaging studies.
PMMA (acrylic bone cement)
A cost-effective and durable solution, shaped during the operation into the desired form.
Hydroxyapatite / calcium phosphate
A material with a composition similar to natural bone, used mainly in paediatric cases because of its ability to “work with” bone growth.
How the operation is performed
Before the operation, the neurosurgeon carefully plans the approach, taking into account the previous incision and preservation of good blood supply to the skin around the area for proper healing.
Where possible, the same incisions from previous operations are used, in order to minimise additional surgical trauma.
The choice depends on the size and shape of the defect. The graft is shaped to fit the site precisely and is fixed with small titanium plates (miniplates) — a modern fixation method that is far more stable than older sutures or wires, with a low profile so that it is not noticeable beneath the skin.
If an implant is used (titanium, PEEK or another material), it is either pre-manufactured on the basis of three-dimensional imaging of your skull for a perfect fit, or shaped by the surgeon during the operation.
After the material has been placed, the incision is closed in layers, often with the use of drains (small tubes) for a few days in order to drain any fluid and promote healing.
Special considerations in children
Cranioplasty in children requires a separate approach, as the skull continues to grow until about the age of 7 years. In most cases, autologous bone or titanium is preferred, while fixation materials are selected carefully so that normal skull growth is not impaired.
What to expect after the operation
As with any surgical procedure, there are possible complications that your neurosurgeon will explain in detail, such as the possibility of infection, collection of fluid beneath the skin, or partial resorption of the bone graft. Proper pre-operative preparation, selection of the appropriate material and close post-operative follow-up significantly reduce these risks.