A depression or soft spot
At the site of the removed bone, there is no support under the skin: the skin sinks or, on the contrary, protrudes.
Discuss your case Cranioplasty is an operation that closes a skull bone defect after trauma, trepanation or removal of part of the bone: with one's own bone or an implant. It is planned together with a neurosurgeon to protect the brain again and restore the shape of the head.
CONCEPTUAL VISUALIZATIONSometimes part of the skull bone has to be removed. This is done in case of a severe brain injury, when it swells and lacks space, as well as in case of a stroke, tumor or infection. This operation is called a decompressive craniectomy, and it is followed by a cranioplasty.
A bone defect remains even after injuries, infections, removal of tumors or due to congenital changes. At this point, the brain is covered only by membranes and skin.
Cranioplasty restores the bone defect. Its purpose is to restore the shape of the head, improve the movement of cerebrospinal fluid and protect the brain again. This can facilitate rehabilitation after an injury.
The skull bone is restored together with a neurosurgeon. There is a separate page about fresh fractures of the forehead called "Fractures of the frontal bone", and about scars on the forehead - "Cicatrical deformity of the forehead".
This is general information. The doctor will tell you what will suit you after the examination.
Some of the changes are visible and can be felt by hand. Others are in a state of well-being, and it is easy to write them off as the effects of trauma.
At the site of the removed bone, there is no support under the skin: the skin sinks or, on the contrary, protrudes.
Months after a craniectomy, the skin over the defect may thicken deeply. Doctors call it the "inflamed flap" syndrome.
Weeks or months after craniectomy, the arm or leg gradually weakens, it becomes harder to speak, think, and drowsiness appears. This is how trepanned syndrome manifests itself — a rare complication in which the condition improves after cranioplasty.
A defect in the area of the forehead or temple changes the contour of the head and face.
Post-traumatic deformation of the faceThe skin over the bone often already has scars from trauma and previous operations.
Cicatricial deformation of the foreheadOften the defect is a consequence of a life-saving operation. It can also be left behind by trauma, infection, or tumor.
In case of a severe brain injury, the bone is removed so that the brain has enough space during swelling. They return it or replace it later.
The same operation is performed for severe stroke, tumors and infections. In a review of 56 patients with trepanned syndrome, trauma was the reason for craniectomy in 43%, tumor removal in 23%.
Fragmented bone fragments cannot always be preserved.
Fractures of the frontal boneOwn bone, which was returned to its place, can gradually dissolve: according to a meta-analysis of 791 such operations - in 20%. This happens more often after an injury.
Infection is the most common complication of cranioplasty: in a meta-analysis, it occurred in 8% of cases (463 of 4,667). Infected bone or an implant sometimes has to be removed.
A long-standing defect of the skull usually does not require emergency care - cranioplasty is planned. But without the bone, the brain in this place is less protected. According to the NHS, call 103 if you have any of the following symptoms (don't drive yourself to hospital):
Immediately - to the surgeon who operated, and if it does not work - to the reception department: after cranioplasty, pain or swelling in the area of the operation increases, fluid oozes from the wound, the wound splits, or the implant shows through the skin. On the same day - for medical assistance after a recent blow to the head, if you have vomited or feel dizzy, take blood-thinning medication, or were intoxicated at the time of the injury. On the same day, to the surgeon: after surgery, a temperature of 38 °C and above, redness or pus in the wound area, if there are no signs from the list for 103. On the same day, to the neurosurgeon: weeks or months after a craniectomy, gradually, day by day, an arm or leg becomes weaker, it becomes harder to speak or think, sleepiness, anxiety, or depression appear, and the skin over the defect sags. Planned: an old defect, a depression on the head or forehead, an uneven contour after a previous operation - make an appointment for a consultation.
Why was the bone removed when it was, was the own bone preserved, were there infections and repeated operations.
Shows the size, shape and edges of the defect. After her, a 3D model of the skull is built for the planning and manufacture of the implant.
The condition of the brain and whether there is hydrocephalus — accumulation of cerebrospinal fluid; this is taken into account when planning the terms of the operation.
The scars and the thickness of the skin are evaluated: is it enough to reliably cover the bone or the implant.
The material is chosen for each defect separately and the advantages and risks of each option are explained.
There are few high-quality studies, so there are no evidence-based guidelines — there is an international consensus on cranioplasty after trauma. There is still no common opinion about which material and which operation period is better, so the plan is drawn up individually.
If it was preserved after craniectomy.
Standard or individual - according to the 3D model of the skull.
Bone defects of the skull at Dr. Valikhnovskyi's Institute of Surgery are restored in the "New Face" direction, where the forehead and skull vault are a separate zone of reconstruction. The terms and scope of the operation are agreed with the neurosurgeon who is treating the patient.
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
Short answers. What is right for you, the doctor will tell you during the consultation.
The decision is made together with the neurosurgeon. Cranioplasty re-protects the brain, reshapes the head, and can aid recovery from injury.
There is no single term. In a meta-analysis of 4,703 patients, surgery before 86 days was associated with better recovery, but hydrocephalus occurred more frequently thereafter. The term is determined by a neurosurgeon.
There is no one-size-fits-all material. The own bone can be resorbed, a wound often spreads over the implants. The material is selected for each defect separately and the risks are explained.
A rare complication after craniectomy: movements, speech, and thinking weaken after weeks or months. In a review of studies, after cranioplasty, the condition improved within a few days on average. If you notice such changes, see a neurosurgeon the same day.
They can In two randomized trials, prophylactic anticonvulsant drugs reduced the number of seizures by nearly 80%. Whether you need them, only a doctor decides.
Yes. In a review of 864 such operations in children, own bone was used in 56% of cases. Complications in children occur quite often - both with their own bone and with implants.
If there is even one sign from the list for 103, call an ambulance. If there was vomiting or dizziness, get medical help the same day. Do not get behind the wheel.
The figures on the page are from these sources.
Send head CT and surgery reports. The doctor will tell if the defect can be closed, with what and when.
Leave your contact details and briefly describe the situation. A coordinator will contact you to agree on the next step.