Cranioplasty in Depressed Skull Fractures: A Narrative Review of the Literature

Abstract

Background

Decompressive craniectomy (DC) is performed routinely following traumatic brain injury (TBI), including depressed fracture (DSF), and following other mass-occupying conditions such as large ischemic strokes. DC could be followed by cranioplasty (CP), which is associated with cosmetic and protective benefits. The appropriate choice of implant, ideal timing, complications, and avoiding reoperation are challenges that neurosurgeons face in CP.

Objective

Our goal is to delineate validatable guidelines for physicians to make decisions based on the latest data in the literature.

Results

CP is not just a cosmetic procedure but also a therapeutic option for patients with depressed fractures. Patients with decompressive craniectomies secondary to other conditions can also develop decompressive craniectomy syndrome needing CP. The choice of materials used for reconstruction is critical to ensure safety and effectiveness. Different alloplastic grafts, such as polymethyl methacrylate, hydroxyapatite, dynamic titanium mesh, and complex mesh patterns, are used in CP, and the advantages and disadvantages must be considered prior to the surgery. Complications are divided into intra- and post-operative groups, and understanding these complications enables the surgeon to diminish the chances of occurrence and enhance surgical consequences. The proper timing of CP following decompressive craniectomy remains controversial.

Conclusion

CP is a simple and useful neurosurgical intervention in those with skull defects. CP provides protective and cosmetic benefits. The main objective of the surgical intervention is to restore the skull to its original shape, protect the brain from further injury and avoid decompressive craniectomy syndrome.