The term cranioplasty refers to both the medical device (the prosthesis) and the surgical procedure aimed at reconstructing part or all of the skull. It is classified as a reconstructive neurosurgical intervention.

Cranioplasty is performed in cases where:

• A cranial fracture has resulted in a bone defect.
• A prior cranial decompression surgery was performed.
• Bone removal was necessary due to tumor invasion.
  
  

These conditions may result from various factors, including:

• Failure in repositioning the autologous bone flap.
• Failure of other materials.
• Traumatic, vascular, or tumor-related conditions.
• Congenital skull defects.
  

The primary indications for cranioplasty are:

1. Brain Protection:

Reconstructing the skull ensures physical protection for the brain, maintains pressure gradients, and supports vascular and cerebrospinal fluid hemodynamics. Without this protection, the risk of direct brain injury increases proportionally to the size and location of the defect.

2. Prevention or Treatment of “Skull Defect Syndromes”:

• Trephined Syndrome: Neurological symptoms such as severe headaches, dizziness, fatigue, discomfort over the cranial defect, anxiety, depression, and intolerance to vibrations.
• Sinking Skin Flap Syndrome: Neurological symptoms caused by external atmospheric pressure exceeding intracranial pressure, leading to a characteristic concavity of the skin flap. Symptoms may include headaches, orthostatic hypotension, fatigue, dizziness, confusion, psychiatric issues (e.g., depression), seizures, and cognitive impairments.

3. Aesthetic Considerations:

Although not purely cosmetic, aesthetic factors significantly impact a patient’s mental and social well-being, often leading to psychological distress that may qualify as a medical condition.

Surgical Approach

Cranioplasty is now considered a routine procedure. However, due to its complexity—requiring detailed planning, potential customization, and consideration of the patient’s condition—it is performed in neurosurgical centers equipped with advanced technologies, such as neuronavigation, to ensure the best possible outcomes.

Skull reconstruction can be performed using:

• Autologous Bone: If available
• Synthetic Biomaterials

These can be:

• Handmade: Manually shaped materials like polymethylmethacrylate (PMMA) or titanium meshes.
• Custom-Made: Pre-designed implants using materials like PMMA, acrylics, polyetheretherketone (PEEK), titanium, porous hydroxyapatite bioceramics, and composites, all well-documented in the medical literature.
  

Cranioplasty is associated with a high rate of postoperative complications. Factors such as the patient’s condition, the type of material used, preservation methods for autologous bone, and surgical timing all influence the outcome, often requiring re-intervention or complete removal of the prosthesis. Common complications include: Infection, Wound dehiscence, Intracranial hemorrhage, Bone resorption, Prosthesis dislocation, Postoperative hematoma, Hydrocephalus, Seizures, Subgaleal fluid collections, Osteomyelitis. It is essential to acknowledge these risks. Despite advancements and extensive experience in the field, severe complications remain a possibility, emphasizing the need for careful, informed decision-making in collaboration with the treating physician.

After discharge, patients must strictly follow the physician’s instructions, which may include using protective accessories if necessary.

Currently, the medical literature does not propose viable alternatives to reconstructive cranioplasty, except for opting out of the procedure and using a protective helmet to mitigate cranial trauma risks. However, helmets cannot address issues such as Trephined Syndrome or the risk of sinking skin flap syndrome.