This article provides a summary of the indications, materials and current techniques available in cranioplasty. Cranioplasty is performed to restore the normal architecture of the skull following craniectomy for many reasons including intracranial infection, trauma and neoplasm. The timing of cranioplasty for intracranial infection is usually between six weeks and one year; there is no consensus on specific timing, instead it is tailored to the patient and allowing adequate time to pass for clearance of infection. There are a wide variety of possible materials for repair of skull defects, with each having advantages and disadvantages. Materials include autografts, allografts, xenografts and bone substitutes. Hydroxyapatite cement can be impregnated with a variety of antibiotics intraoperatively and has good osteoconductvity, but is fragile and cracks easily. Methyl methacrylate is easier to shape and is stronger but has poor osteoconducitvity. Composites are available and show excellent promise for the future. Peri-operatively the procedure is challenging due to neovasularisation and tissue plane distortion from previous surgery/infection. Technique varies depending on graft material used. Care to reflect the temporalis muscle from the skull defect is vital for optimal cosmesis. Cranioplasty can carry a significant morbidity risk including, bone resorption, surgical site infection, seizure, hydrocephalus, haematoma and subdural hygroma formation. This paper has given an informative overview of cranioplasty, but the authors highlight the need for larger, prospective, multi-centre studies to aid the surgeon’s choice of material for grafting, specifically looking at clinical outcome, patient satisfaction, complication rates and relative cost.

Piazza M, Grady MS.
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Aaron SJ Ferguson

Victoria Hospital, Kirkcaldy, NHS Fife, UK.

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