Cranioplasty, Softcover reprint of the original 1st ed. 1984
Indications, Techniques, and Results

This monograph presents a comprehensive review of the clinical experience in surgical repair of cranial defects which the author has gained during a period of over ten years. Particular problems of patients undergoing cranioplasty, such as neurological impairments, EEG changes, variations of intracranial pressure, and sinking skin flap syndrome are described and discussed. The author presents convincing evidence of the importance of cranioplasty in improving the quality of life of patients with large and disfiguring cranial defects. Unfortunately, cranioplasty still ameliorates only to a minimal extent the general condition in patients suffering of major cerebral lesions. I am convinced that this volume will serve the purpose it was designed for : that it will be a most helpful introduction into the problems related to reconstructive surgery. Basel, August 1984 Otmar Gratzl Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 A. History of Cranioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 B. Clinical Aspects of Cranial Bone Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 I. Origin of Cranial Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1. Acquired Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2. Congenital Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3. Demographic and Other Characteristics of Patients . . . . . . . . . . . . . . . . . 9 II. Neurological and Psychic Changes Before and After Cranioplasty . . . . . . . 11 1. Classification of Neurological Deficits and of the Skin Flap Types . . . . . 13 2. The "Sinking Skin Flap Syndrome" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3. The Influence of Cranioplasty Upon Neurological and Psychic Changes 17 III. Electroencephalographic (EEG) Changes in Patients with Cranial Defects 21 1. EEG Recordings and Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. Evaluation of EEG Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 IV. Scintigraphy Findings in Patients with Cranial Bone Defects . . . . . . . . . . . . 26 1. Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2. Results and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

A. History of Cranioplasty.- B. Clinical Aspects of Cranial Bone Defects.- I. Origin of Cranial Defects.- 1. Acquired Defects.- 2. Congenital Defects.- 3. Demographic and Other Characteristics of Patients.- II. Neurological and Psychic Changes Before and After Cranioplasty.- 1. Classification of Neurological Deficits and of the Skin Flap Types.- 2. The “Sinking Skin Flap Syndrome”.- 3. The Influence of Cranioplasty Upon Neurological and Psychic Changes.- III. Electroencephalographic (EEG) Changes in Patients with Cranial Defects.- 1. EEG Recordings and Casuistic.- 2. Evaluation of EEG Changes.- IV. Scintigraphy Findings in Patients with Cranial Bone Defects.- 1. Casuistic.- 2. Results and Discussion.- V. Intracranial Pressure Changes Before and After Cranioplasty.- 1. Casuistic.- 2. Preoperative Pressure Readings.- 3. Postoperative Pressure Readings.- 4. Pathophysiology of Increased Intracranial Pressure in Uncovered Skull Defects.- C. Surgical Procedures and Techniques of Cranial Repair.- I. Indications for Cranioplasty.- 1. Prevention of Hemisphere Collapse.- 1.1 Case Reports.- 2. Treatment of CSF Cysts.- 3. Protection Against Mechanical Influences.- 4. Cosmetic Restoration.- II. Contraindications.- 1. Raised Intracranial Pressure and Brain Prolapse.- 2. Skin Necrosis.- 3. Localized and General Infections.- 4. Cranial Defects with Communication to Paranasal Sinus.- 5. Small Cranial Defects.- III. Material Used for Cranioplasty.- 1. Bone Grafts.- 1.1 Autologous Grafts.- 1.1.1 Periosteum-Bone Flap.- 1.1.2 Tibial Grafts.- 1.1.3 Rib Grafts.- 1.1.4 Iliac Crest Grafts.- 1.1.5 Scapula and Sternum Grafts.- 1.1.6 Cartilage Grafts.- 1.2 Homologous Grafts.- 1.3 Heterologous Grafts.- 2. Materials Other than Bone.- 2.1 Metals.- 2.2 Acrylates.- IV. Conservation Procedures.- 1. The Problem of Bone Graft Conservation.- 2. Methods of Conservation.- 2.1 Deep Freezing.- 2.2 Conservation Under the Abdominal Wall.- V. Operative Technique.- 1. General Considerations.- 1.1 Flap Formation.- 1.2 Anaesthesia/Position.- 1.3 Haemostasis.- 2. Operative Procedure — Preparatory Steps.- 2.1 Preparation of the Skin Flap.- 2.2 Bone Transplant.- 2.3 Particular Problems of “Sinking Skin Flap Syndrome”.- 3. Cranial Repair Procedure with Bone Transplants.- 3.1 Homologous Bone.- 3.2 Autologous Bone.- 3.2.1 Autologous Bone — Conserved Under the Abdominal Wall.- 4. Cranial Repair Procedure with Acrylates.- D. Complications of Cranioplasty.- I. With Bone Transplants.- II. With Bone Cements.- E. Cranioplasty in Children.- I. General.- II. Special Problems.- F. General Conclusion.- References.