Best time for cranioplasty

The skull is a hard outer shell that protects the brain tissue. Without the protection of this outer shell, the brain tissue is more vulnerable to damage. Although the skull is hard, it is actually very easy to be injured. Bumps and collisions in daily life can easily cause damage to the skull, which may cause gaps in the skull. Once the skull is damaged, it must be repaired in time. So when is the best time for cranioplasty?

Cranioplasty is a common neurosurgery procedure that repairs skull defects caused by brain trauma and craniotomy.

Removal of bone flaps in craniocerebral trauma and brain surgery, resection of benign skull tumors or tumor-like tissues, chronic skull osteomyelitis, etc. As the shape of the skull defect area changes, the scalp is affected by atmospheric pressure, causing it to sink inward and compress the brain tissue.

Purpose

In addition to solving problems such as lack of effective protection of brain tissue in the defect area, blood supply disorders, abnormal cerebrospinal fluid circulation, etc., it is also necessary to solve the problem of external appearance repair and plastic surgery.

Precautions

Patients often have a heavy mental burden such as a sense of insecurity, which may cause syndromes such as headaches, dizziness, and fear of vibration. The longer the skull defect lasts, the higher the incidence of skull defect syndrome and secondary brain damage. In order to restore the airtightness of the cranial cavity, maintain the stability of physiological intracranial pressure, and alleviate skull defect syndrome. Cranioplasty should be performed on skull defects with a diameter of more than 3 cm, without muscle coverage, and without contraindications. It is generally believed that repair is best done 3 to 6 months after craniotomy; children can undergo shaping surgery after 3 to 5 years of age.

Material selection

Because it is a repair of skull tissue, the material selection must first have high biocompatibility, and at the same time must ensure a certain level of strength and rigidity, providing sufficient protection while also meeting the needs of intraoperative shaping to achieve satisfactory results in appearance restoration and cosmetic surgery.

Timing of surgery

Three months after the frontal bone defect, the pressure at the frontal bone defect site was not high, and there were no factors such as infection and ulcer that were not conducive to wound healing.

Preoperative preparation

All patients had no contraindications to surgery and underwent head CT and frontal bone X-ray examinations. The digital molding group routinely underwent thin-layer CT scanning with a layer thickness of 2 mm and performed three-dimensional reconstruction of the frontal bone. The two-dimensional titanium mesh was then molded using a "titanium mesh digital molding machine" to produce a two-dimensional personalized titanium mesh restoration that was completely consistent with the patient's frontal bone defect, which was then sterilized for use. The three-dimensional easy-to-mold group selected a three-dimensional easy-to-mold titanium mesh that was more than 2 cm larger than the defect edge, pre-molded it using a traditional mold, and sterilized it for use.

Surgical Procedure

All patients underwent endotracheal intubation and general anesthesia, and underwent covering repair. In the three-dimensional easy-to-shape group, the titanium mesh was cut and manually shaped according to the size and shape of the patient's frontal bone defect to meet the requirements of the patient's defect site as much as possible. The edges were polished smooth and placed in the bone window, and fixed with matching self-tapping titanium nails. Antibiotics were routinely used to prevent infection, the drainage tube was removed after 1 to 2 days, and the stitches were removed after 10 to 12 days.

Efficacy judgment

The patients were observed for wound healing, plastic surgery effects, and complications in the short term after surgery, and the efficacy was finally evaluated according to the following criteria during the follow-up 3 months later. ①Excellent: The titanium alloy mesh is reliably fixed, the appearance is beautiful, and no complications occur after surgery; ②Good: The titanium alloy mesh is reliably fixed, and the postoperative complications improve after symptomatic treatment; ③Poor: The titanium alloy mesh slips and shifts,