What is Alloplastic Cranioplasty?

A neurosurgeon will perform a craniectomy for multiple conditions including tumor removal, trauma (intracranial bleeding), or infection. A craniectomy procedure is the removal of a portion of the skull to gain access to the intracranial space. Often, the piece of bone that was removed (bone flap) can be placed back using plates and screws. However, in certain cases the bone flap needs to be removed for longer periods of time or permanently. Some reasons for this are infection or to allow the brain space to swell. In most cases, the patient’s bone flap can be replaced; this is called an autogenous cranioplasty. In certain cases, the bone flap is not usable and so an implant needs to be made to replace it. Alloplastic means a material that is not from the patient’s own body. Cranioplasty is a surgery to repair a defect or deformity of the skull.

Why does a Patient Need a Cranioplasty?

There are multiple reasons that patients need a cranioplasty after craniectomy, some of them are:

• One of the most important indications is to protect the brain. Without the bone in place, patients have to wear a helmet to protect their brain when up out of bed.
• Another important reason for cranioplasty is to stablize CSF hydrodynamics.
• Without the bone flap or an alloplastic implant in place, the patient will have a noticeable cosmetic deformity. Performing a cranioplasty restores the cranial symmetry.

Why Should a Craniofacial Plastic Surgeon Perform the Cranioplasty?

Craniofacial plastic surgeons are typically asked to be involved with a cranioplasty if there are concerns about wound healing or the skin quality is poor. Since a bone flap and an implant are non-vascularized, they are susceptible to infection. If the skin quality is poor, then this puts the patient at risk for developing an overlying wound which could get infected. If an infection develops in the bone flap or implant, then it has to be removed and the patient treated with weeks of antibiotics before another cranioplasty can be performed.

Another benefit of having a craniofacial plastic surgeon perform the cranioplasty is when  we take into consideration facial aesthetics during surgery. During a craniectomy, the temporalis muscle is taken down from the skull and this causes a noticeable deformity called temporal hollowing. A plastic surgeon will resuspend the temporalis muscle to prevent this deformity.

See the video below which shows the implant design process and the steps that the Craniofacial Team of Texas Plastic Surgeons take ensure a good outcome after cranioplasty.