Plastic Surgeons Develop New Skull Reconstruction Method for Complex Cranioplasty Scenarios
According to plastic surgeons, they were able to create a new method for complex skull reconstruction surgery that promises to improve functional and aesthetic results in situations that have been declared impossible or unsafe, leaving patients with bad skull deformities.
An online journal site, called Journal of Neurosurgery, had reported a case study, with a Johns Hopkins craniofacial plastic surgeon, that involves a patient who received benefits from a technique that reshaped the outer lining of his brain. What the surgeons did was reform his huge skull defect using a mix of metal and acrylic, which is known to be a cranioplasty.
The surgery was conducted at the Massachusetts General Hospital (MGH), headed by Dr Chad R. Gordon, who is currently an assistant professor in the Department of Plastic and Reconstructive Surgery at the Johns Hopkins University School of Medicine and former craniomaxillofacial fellow at Harvard Medical School. The patient was set to have a brain tumor removed via neurosurgery, which was worsened by a severe bone infection, needing partial removal of his skull bone. This created a major deformity and left part of his brain exposed. He was prescribed to wear a helmet for protection. As more time was required to clear the infection, his brain expanded beyond the limits of his original skull, leaving conventional skull reconstruction techniques useless.
“Thousands of patients each year worldwide require neurosurgical procedures. Unfortunately, many are left with residual skull deformities because of unforeseen complications. This gives craniofacial surgeons a new weapon for reconstructing the human skull,” said Dr Gordon.
Gordon and fellow doctors devised a new approach they call a “bipolar duraplasty” to temporarily treat the patient’s herniation. With this method, the surgeons used low-level heat in a careful, precise fashion to effectively shrink the brain at once and reconstruct the skull with cranioplasty. Both metal and plastic were used in place of the missing skull, serving to provide adamant brain protection and improve its aesthetic look. Bipolar cautery, which they used in this instance, is the first known case in which craniofacial surgeons used to temporarily resize the brain.
All it took the surgeons to apply this maneuver are extensive surgery knowledge and experience to counter a difficult problem. Had it not been used, the patient would’ve received partial brain resection — a tricky skull reshaping procedure — or been required to wear the helmet permanently, according to Gordon.
After the patient’s surgery, he was closely observed for a year and, fortunately, no complications developed. Dr Gordon wishes to test the technique’s long-term results in similar cranioplasty cases if the opportunity comes along.
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