Decision-Making in Adult Cranial Vault Reconstruction

Abstract

efects of the cranium may result from various causes: traumatic loss, neurosurgical intervention, skull tumors, infection, and congenital abnormalities. 1 The purpose of cranioplasty is to accurately restore the integrity and surface morphology of the skull using a permanent and durable reconstruction. This is done for both cosmetic and functional purposes. 2 The choice of reconstruction in cranioplasty may be divided into two broad categories: autologous bone and alloplastic materials. Autologous bone provides reparative capabilities and the potential for at least partial consolidation and revascularization. It features superior infection resistance and is less likely to extrude. However, it is also susceptible to resorption, can be difficult to shape, and is associated with donor-site morbidity. 3,4 Alloplastic materials were designed to circumvent these problems. They provide permanent shape and volume retention, but do not incorporate into the skeleton and are more susceptible to both infection and extrusion. 5 The recent advent of computer-designed, patient-specific, three-dimensional implants has revolutionized cranioplasty. Even in experienced

Expanding Our Role in Headache Management

“…Fortunately, a cranioplasty can help treat both dural conditions and is likely the first step for any patient presenting with PCH and a cranial defect. The options for cranioplasty are extensive and have been thoroughly reviewed elsewhere in the literature 48,49 …”

“…The options for cranioplasty are extensive and have been thoroughly reviewed elsewhere in the literature. 48,49 Temporalis Injury Derangement of the temporalis muscle and temporomandibular joint (TMJ) is probably the least understood cause of PCH, and likely, the pathology is different in each patient; hence, there is no singular treatment. This makes temporal PCH one of the most challenging to treat.…”

Unveiling the “Kebab” technique: A case report on a two-stage reconstruction method for repeated complex cranioplasty

“…[8] On the other hand, autologous tissue transfer with abundant volume and vasculature is indicated for complicated cranioplasty such as intolerance to foreign materials, recurrent infection, and soft-tissue insufficiency. [9][10][11][12] However, one-stage cranioplasty with an osseous chimeric flap inevitably creates a dead space underneath the rigid bony structure, while intracranial dead space > 2 cm was associated with fluid accumulation and reconstructive failure. [13] Early reconstruction before the subsidence of the infection often leads to devastating outcomes.…”

Scalp and Dural Reconstruction With a Tensor Fascia Lata Myofascial and Anterolateral Thigh Fasciocutaneous Chimeric Flap: A Case Report

“…Large defects with high-risk features including infection, radiation, and multiple prior surgeries are best served with free tissue transfer. 1,[3][4][5][6][7][8][9] Concomitant dural defects require additional reconstruction with a watertight closure to separate the brain parenchyma and CSF from the overlying soft tissue. 3 Cranioplasty is typically staged in the setting of active infection in order to reduce risks of complications.…”

“…3 Cranioplasty is typically staged in the setting of active infection in order to reduce risks of complications. 4,5 The anterolateral (ALT) fasciocutaneous flap is frequently used for complex head and neck defects due to its component parts. However, a limitation of the traditional ALT flap in composite cranial defects is that it does not allow for a watertight dural repair because the pedicle must exit the intracranial undersurface of the flap for extracranial anastomosis.…”