Cranioplasty

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Dr Keith Goh
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What is Cranioplasty?

Cranioplasty is a surgical procedure designed to repair defects or deformities of the skull. This operation aims to restore the structural integrity of the skull to shield the brain from potential harm. More importantly, it helps to restore the normal intracranial pressure, which leads to improved cerebral blood flow.

The procedure involves the placement of a cranial implant, which can be made from various materials, including the patient’s own bone (autograft), biocompatible material (such as PCL), or synthetic materials like titanium or polymethyl methacrylate (PMMA). The choice of material and the specific techniques used are determined based on the size and location of the skull defect, as well as the patient’s overall health and specific needs.

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Skull reconstructed with titanium

Indications for Cranioplasty

Cranioplasty is indicated for a variety of conditions that result in cranial defects or deformities. These indications broadly encompass both acquired and congenital cranial abnormalities, aiming to restore skull integrity, protect cerebral tissues, restore normal intracranial pressure, improve blood flow to the brain, and improve aesthetic outcomes. The primary indications include:

  • Post-Craniectomy Reconstruction: Following a craniectomy, which is the surgical removal of a portion of the skull to relieve intracranial pressure often due to traumatic brain injury, stroke, infection or other conditions causing increased intracranial pressure.
  • Traumatic Brain Injuries: To repair skull fractures or deformities resulting from accidents or injuries.
  • Congenital Skull Anomalies: For the correction of congenital deformities that can affect brain development or lead to other complications.
  • Surgical Resection: After the removal of skull tumours or infection-induced necrotic bone, to fill the resultant defect.
  • Cosmetic Restoration: To address aesthetic concerns that may arise from skull deformities, significantly impacting the patient’s quality of life.
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Surgical Process

The cranioplasty procedure involves several key steps, from pre-operative planning (including 3D radiologic scans and patient-customized implants) to the surgical procedure itself, followed by post-operative care. Each phase is critical for ensuring the success of the surgery and the well-being of the patient.

  1. Pre-operative stage: 3D radiologic scans, Pre-fabrication of customized patient-specific implant.
  2. Anaesthesia: General anaesthesia is administered to ensure the patient is unconscious and pain-free throughout the procedure.
  3. Incision and Exposure: A scalp incision is made over the area of the skull defect to expose the underlying bone.
  4. Implant Placement: The selected material is prepared, shaped, and tailored to fit the defect precisely. If an autologous bone graft is used, it may have to be reshaped; alloplastic materials would have been custom-made pre-operatively. The implant is then positioned to cover the skull defect and secured with plates, screws, or other fixation devices to ensure stability.
  5. Closure: The scalp is closed over the implant using sutures or staples, ensuring a clean and secure wound closure.
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Benefits of
Cranioplasty

Cranioplasty offers several important benefits that contribute to the overall well-being and quality of life of patients undergoing the procedure. Key benefits include:

  • Restoration of Cranial Protection: By repairing the skull defect, cranioplasty restores the protective barrier around the brain, shielding it from injury.
  • Neurological Improvement and Symptom Relief: Patients often experience a reduction in symptoms related to the skull defect, such as headaches or seizures. There is evidence that cranioplasty improves cerebral blood flow and cognitive function in patients.
  • Cosmetic Benefits: Cranioplasty can significantly improve the appearance of the skull, addressing deformities or irregularities. In conjunction with other rehabilitative services, cranioplasty can be a crucial step in the patient’s overall functional recovery, allowing them to return to daily activities and, in some cases, work.
  • Reduced Risk of Future Complications: Re-establishing skull integrity helps prevent potential complications that could arise from exposure of the brain to external forces or infections.


Recovery and Rehabilitation After Cranioplasty

The duration and specifics of recovery can vary widely depending on the individual’s overall health, the complexity of the surgery, and the type of materials used. Here are the general stages and considerations during the recovery phase:

  • Immediate Postoperative Period: Patients typically spend a few days in the hospital post-surgery to allow for close monitoring of any immediate complications, such as signs of infection, bleeding, seizures or neurological changes. Pain and discomfort at the surgical site can be managed with prescribed pain medications, ensuring the patient’s comfort during the initial recovery phase.
  • Rehabilitation: Some patients may benefit from physical therapy to strengthen the muscles around the neck and shoulders, improve mobility, and facilitate overall recovery. Regular check-ups with the surgical team are also important to monitor the healing process, assess the integration of the implant, and address any concerns that may arise.
  • Long-term Care: Ongoing vigilance for signs of infection, implant issues, or neurological changes is important. Making healthy lifestyle choices, such as maintaining a balanced diet, regular exercise, and avoiding activities that could risk injury to the head, can help support long-term recovery and well-being.
  • Returning to Normal Activities: Many can begin to resume normal, non-strenuous activities within a few weeks, but full recovery and the return to more demanding tasks can take several months.

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Dr. Keith Goh

MBBS (SG)

FRCS (ED)

FCSHK

FHKAM

FAMS

With more than 20 years of experience in the field of Neurosurgery, Dr Keith Goh’s subspecialty includes treatment of brain and spinal cord tumours and pediatric neurosurgery.

He is the Medical Director of International Neuro Associates, which is based at Mount Elizabeth Medical Centre, and provides specialist neurological services to all the hospitals within the Parkway Pantai hospital group. He also was Honorary Associate Professor of Neurosurgery at the Prince of Wales Hospital of the Chinese University of Hong Kong.

  • Bachelor of Medicine & Surgery — National University of Singapore
  • Neurosurgical Residency at the Chinese University of Hong Kong
  • Advanced specialty training in paediatric neurosurgery at the Beth Israel Institute of Neurology & Neurosurgery in New York

His bibliography includes 40 original articles, 11 book chapters, and 104 abstracts and lectures on his various research interests, such as brain tumours, spinal cord tumours, head trauma, conjoined twins and congenital malformations in children.

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Mount Elizabeth Medical Centre,
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Singapore 228510

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    Mount Elizabeth Medical Centre,
    #09-10, 3 Mount Elizabeth
    Singapore 228510

    Frequently Asked Questions

    How is the material for cranioplasty chosen?

    The choice of material for a cranioplasty is determined by several factors, including the size and location of the skull defect, the patient’s age and overall health, the potential for bone growth (particularly in children), and specific goals of the surgery such as cosmetic appearance and durability.

    Autologous bone, if available, is preferred for its biocompatibility and potential for integration, but synthetic materials may be selected for their ease of use, and durability, especially when autologous bone is not suitable or available.

    How long does the cranioplasty implant last?

    Autologous bone grafts have the potential to integrate fully into the surrounding bone, potentially lasting a lifetime. Alloplastic materials, such as titanium or synthetic polymers, are designed for durability and can also last a lifetime under optimal conditions.

    Most recently, biocompatible and bioresorbable implants (such as PCL) are used – these are often augmented with growth factors and mesenchymal stem cells, for long-term integration of the implant. Factors such as infection, trauma, or the body’s reaction to the implant can affect its longevity, necessitating monitoring and potentially future revisions.

    Can children undergo cranioplasty, and how does it differ from adults?

    Children can undergo cranioplasty, especially in cases of congenital skull anomalies or after trauma. The approach to cranioplasty in children differs from adults due to considerations of ongoing skull growth and development. The potential for bone regeneration is higher in children, which may influence the choice of graft material.