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All topics
  1. What it is
  2. Why it matters
  3. Timing
  4. The procedure
  5. Patient journey
  6. Recovery supplies
  7. Implant materials
  8. Side-by-side
  9. US manufacturers
  10. What the evidence says
  11. Value analysis
  12. Questions to ask
  13. Glossary
  14. Resources
  15. References

Purpose

Why it matters beyond appearance

Restoring the shape of the head is important, and so is protecting the brain from injury. But cranioplasty can also help how the brain works. Without bone covering it, the brain is exposed to atmospheric pressure through the scalp, and blood and fluid flow can be disturbed.

Some patients develop the syndrome of the trephined (also called sinking skin flap syndrome): the scalp sinks inward and the person gets worse, with weakness, reduced alertness, mood changes, speech problems or headache. Cranioplasty can reverse these symptoms.2

Clinical detail
  • A systematic review of 21 studies (205 patients) measuring cerebral hemodynamics before and after cranioplasty found that every study showed increased cerebral blood flow on the side of the repair, and 9 of 21 also showed a contralateral increase. Most patients improved neurologically, though causality between CBF and function is not established.1
  • In a review of 56 reconstructed SoT patients, the most common deficits were motor (52%) and reduced wakefulness (30%). Symptoms appeared a mean of 4.4 months after decompression, and TBI was a risk factor (adjusted OR 8.2). Time to neurological improvement did not differ between autologous and alloplastic reconstruction.2

Sources for this page

  1. Halani SH, et al. Effects of cranioplasty on cerebral blood flow following decompressive craniectomy: a systematic review. Neurosurgery. 2017;81(2):204-216. doi:10.1093/neuros/nyx054
  2. Mustroph CM, et al. Systematic review of syndrome of the trephined and reconstructive implications. J Craniofac Surg. 2022;33(6):e647-e652. doi:10.1097/SCS.0000000000008724

All references