Cranioplasty surgery after stroke

Cranioplasty surgery after stroke


Who performs the procedure?

What happens before surgery?

What happens in the surgery?

Recovery from Cranioplasty

Cranioplasty Risks

How long does it take to recover from Cranioplasty?

 Cranioplasty is a surgical procedure performed to restore a defect on the cranial vault after a previous decompressive craniectomy made for traumatic brain injury, ischemic or hemorrhagic disease, or even after the removal of cranial tumors. Although apparently it may resemble an easy and routine surgical procedure, cranioplasty has a rate of complications up to 41% of cases. The most frequently reported complications are infections, autologous bone flap resorption, and hematomas. Other possible complications are wound dehiscence, seizures, hygroma, and poor cosmetic results. In this paper we report an overview of the possible complications deriving from cranioplasty. The most evident causes of complications are discussed, suggesting, when possible, solutions to avoid or limit them.

It is generally considered optimal to use the patient’s original bone if it remains functional. However, in cases where the bone has been badly damaged or removed, there are several options available. Prior to the surgery, it will be determined exactly what substance will be used to replace the bone. Depending on a number of factors, the surgeon may choose to graft a piece of bone that has been removed from the patient’s rib, skull or pelvis; use a bone substitute made from a synthetic material; or employ an acrylic insert that can be fitted into the defective area. All of these are attached to the nearby bones with titanium plates and screws.

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Who performs the procedure?

A craniotomy is performed by a neurosurgeon; some have additional training in skull base surgery. A neurosurgeon may work with a team of head-and-neck, otologic, oculoplastic and reconstructive surgeons. Ask your neurosurgeon about their training, especially if your case is complex.

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What happens before surgery?

In the doctor's office you will review the procedure with your neurosurgeon and have time to ask questions. Consent forms are signed and paperwork completed to inform the surgeon about your medical history (e.g., allergies, medicines, anesthesia reactions, previous surgeries). Several days before surgery, your primary care physician will conduct tests (e.g., electrocardiogram, chest x-ray, and blood work) to make sure that you are cleared for surgery.

It is important that you discontinue all non-steroidal anti-inflammatory medicines (Naproxen, Advil, etc.) and blood thinners (Coumadin, heparin, aspirin, Plavix, etc.), typically at least 1 week before surgery. Additionally, stop smoking, chewing tobacco, and drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems.

If image-guided surgery is planned, an MRI will be scheduled before surgery. Fiducials (small markers) may be placed on your forehead and behind the ears. The markers help align the preoperative MRI to the image guidance system. The fiducials must stay in place and cannot be moved or removed prior to surgery to ensure the accuracy of the scan.

  • Do not eat or drink after midnight the night before surgery.
  • Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
  • Wear flat-heeled shoes with closed backs.
  • If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
  • Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
  • Leave all valuables and jewelry at home.
  • Bring a list of medications with dosages and the times of day usually taken.
  • Bring a list of allergies to medication or foods.

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What happens in the surgery?

After anesthesia, the surgeon carefully cuts the patient's skin and gently divides it into separate layers, cleaning the edges of the surrounding bone and preparing the surface so that the bone or implant can be properly damaged at the site. By placing a bone or implant in place, the bleeding is controlled, and the surgeon will re-return your skin to its first place and stitches. After surgery, the patient may suffer from severe pain, which can be relieved with pills and infusions if you notice the following severe cases. 

What to Expect

If you don’t already have a referral, schedule an appointment with one of our cranioplasty specialists. The surgeon will examine your skull and ask questions to determine if you’re a candidate for a cranioplasty procedure. If surgery is recommended, you’ll discuss risks and potential complications of surgery and what will happen during surgery. You will receive directions on what to do prior to your surgery.

During your surgery, you will receive anesthesia to avoid feeling pain. While you are unconscious, the surgical team will prepare your skull with a local anesthetic to further prevent pain.

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Recovery from Cranioplasty

  • Immediately After Surgery

Afterward, you will spend time recovering in a post-anesthesia care unit, where your care team will monitor your heart rate, breathing and other vital signs. As you stabilize, you will be assessed for any potential side effects and will be cleared to move to your recovery room.

In the time immediately following your procedure, you will likely feel noticeably fatigued. You may need to take naps during the day, which is a normal part of the healing process and allows your body to rest. This fatigue can last for a period of weeks. Many patients also experience headaches following cranioplasty. However, these can be managed using over-the-counter or prescription medications, as needed.

  • The Week After Surgery

Most patients will spend one to two days recovering in the hospital following a cranioplasty. Your recovery time will depend on your personal health factors, as well as the condition being treated with the cranioplasty. Your own doctor will be the best person to give you an idea of what to anticipate following your cranioplasty.

After a week or so, you will be released to begin your recovery at home.

  • A Month After Surgery

You can expect to be on activity restrictions for a period of six to 12 weeks. Early in your recovery, you will be limited to activities such as carrying weight, driving and exercise. As you attend follow-up appointments and your doctor assesses your recovery, he or she will gradually ease your activity restrictions.

Because there are different types of cranioplasty used to treat various conditions, you will need to speak with your personal doctor about what to expect regarding symptom relief. Some patients will experience immediate relief from any symptoms that necessitated treatment, though this is a very personal process and will be most accurately assessed by your own doctor.

Cranioplasty Risks

All surgical procedures carry some form of risk. The most common risks associated with a cranioplasty include infection, blood clot formation, seizures and stroke. Choosing an experienced surgeon who has performed this procedure many times can lessen the chance of developing a complication after undergoing a cranioplasty.

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How long does it take to recover from Cranioplasty?

You will be given a follow-up appointment 10 to 14 days after surgery. The recovery time varies from 1 to 4 weeks depending on the underlying disease being treated and your general health. Full recovery may take up to 8 weeks. Walking is a good way to begin increasing your activity level.

Is Cranioplasty dangerous?

No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. Specific complications related to a craniotomy may include stroke, seizures, swelling of the brain, nerve damage, CSF leak, and loss of some mental functions.

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Is craniotomy a serious surgery?

A craniotomy is a brain surgery that involves the temporary removal of bone from the skull to make repairs in the brain. It is highly intensive and comes with certain risks, which make it a serious surgery.

Is Cranioplasty necessary?

Cranioplasty is required for protecting the brain exposed through the skull defect brain, and also for cosmetic purposes. Moreover, there is an increasing body of evidence in the recent literature, which demonstrates that cranioplasty may also accelerate and improve neurological recovery. Cranioplasty might be performed for any of the following reasons:

  • Protection: In certain places, a cranial defect can leave the brain vulnerable to damage.
  • Function: Cranioplasty may improve neurological function for some patients. In some instances, a customized cranial implant is designed ahead of time to help the surgeon obtain an ideal shape and outcome, as well as to house embedded neuro technologies.
  • Aesthetics: A noticeable skull defect can affect a patient’s appearance and confidence.

Headaches: Cranioplasty can reduce headaches due to previous surgery or injury.

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What is considered a late postoperative complication following craniotomy?

A late complication following craniectomy is the “sinking” of the skin flap over the surgical site, known as the “Sunken brain and Scalp Flap Syndrome”(SSFS) or “Motor Trephine Syndrome” (MTS).

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What can I expect after a decompressive craniectomy?

Some people will remain unconscious for days or weeks following surgery. Some may even be in a coma or vegetative state.

Following a craniectomy, it is essential to protect the brain from further injury. This usually requires the individual to wear a custom-fitted helmet for several weeks to several months.

Less frequently, a person might wear a temporary brain implant to stabilize the brain and skull. A surgeon will remove this implant at a later date.

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What are the side effects of a craniotomy?

Your risk of complications depends on many factors, including your specific brain surgery and medical condition.

Possible complications include:

  • head scarring
  • dent where bone flap was removed
  • injury from the head device
  • facial nerve damage
  • damage to the sinuses
  • infection of the bone flap or skin
  • seizures
  • brain swelling
  • leaking of cerebrospinal fluid
  • muscle weakness
  • stroke

Rarely, a craniotomy may lead to:

  • speech problems
  • memory problems
  • balance issues
  • paralysis
  • coma

A craniotomy can also cause general surgical side effects like:

  • bleeding
  • blood clots
  • pneumonia
  • reaction to general anesthesia
  • unstable blood pressure

If you’re worried about these complications, talk to your surgeon.

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10 common questions about Cranioplasty surgery after stroke

1What is cranioplasty surgery?
Cranioplasty is a neurosurgical procedure designed to repair or reshape irregularities or imperfections in the skull. A bone graft from elsewhere in the body or a synthetic material may be used to repair defects or gaps in the cranial (skull) bones
2Is Cranioplasty dangerous?
Cranioplasty Risks The most common risks associated with a cranioplasty include infection, blood clot formation, seizures and stroke. Choosing an experienced surgeon who has performed this procedure many times can lessen the chance of developing a complication after undergoing a cranioplasty
3Is Cranioplasty necessary?
Cranioplasty is required for protecting the brain exposed through the skull defect brain, and also for cosmetic purposes. ... The optimal timing for performing a cranioplasty seems to play an important role not only in avoiding procedure-associated complications, but also in the neurological outcome of these patients
4Is a Cranioplasty brain surgery?
Cranioplasty is a surgical procedure performed to restore a defect on the cranial vault after a previous decompressive craniectomy made for traumatic brain injury, ischemic or hemorrhagic disease, or even after the removal of cranial tumors.
5Does hair grow back after craniotomy?
After the operation, your hair will grow back where it has been shaved. Once the wound on your head has healed, and your stitches or clips have been removed, you can wash your hair and use hair products as usual. You can also dye or treat your hair once the wound has healed.
6Do they replace skull after brain surgery?
If part of the skull bone is removed and not replaced right away, it is called craniectomy. This is done if swelling is likely after brain surgery or if the skull bone flap can't be replaced for other reasons. After a few weeks to months, you may have a follow-up surgery called a cranioplasty
7What does Cranioplasty mean?
Cranioplasty is a surgical repair of a defect or deformity of a skull. Cranioplasty is almost as ancient as trepanation. There is evidence that Incan and Muisca surgeons were performing cranioplasty using precious metals and gourds
8Why do they put skull in abdomen?
Why place a piece of skull in someone's stomach? ... In a decompressive craniectomy, doctors remove a portion of the skull in order to relieve the pressure associated with swelling. The skin of the scalp is then sewn together with the dura mater, a tough membrane that covers the brain.
9Can the skull heal?
Most skull fractures aren't too painful, and the skull will heal itself in a majority of these instances. ... Surgery is more often a required course of treatment for depressed skull fractures if the depression is severe enough. This is because depressed skull fractures have a harder time healing on their own.
10Is craniotomy a major surgery?
A craniotomy is the surgical removal of part of the bone from the skull to expose the brain. Specialized tools are used to remove the section of bone called the bone flap. The bone flap is temporarily removed, then replaced after the brain surgery has been done.

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