Name of the Procedure:

Cranioplasty with Autograft (includes obtaining bone grafts); up to 5 cm diameter

Summary

Cranioplasty with autograft is a surgical procedure that involves repairing a defect or deformity in the skull using the patient's own bone, typically harvested from another part of the body. This procedure focuses on defects up to 5 centimeters in diameter.

Purpose

Cranioplasty with autograft addresses defects in the skull that may result from trauma, previous surgeries, congenital anomalies, or disease. The primary goals are to protect the brain, restore the normal shape of the skull, and improve the patient’s aesthetic appearance.

Indications

• Skull defects resulting from injury or surgery
• Congenital skull deformities
• Cosmetic and protective reconstruction after the removal of bone flap (e.g., after decompressive craniectomy) Patient suitability typically includes those with good overall health and adequate bone donor sites.

Preparation

• Fasting for at least 8 hours before surgery
• Discontinuation of certain medications (e.g., blood thinners) as directed by the physician
• Preoperative imaging studies such as CT or MRI scans
• General health assessment and blood tests

Procedure Description

1. Anesthesia: The patient is put under general anesthesia.
2. Incision: An incision is made over the area of the skull defect.
3. Bone Harvesting: A piece of bone is harvested from another site, like the pelvis or ribs, and is shaped to fit the defect.
4. Placement: The harvested bone is placed into the defect and secured with plates and screws as needed.
5. Closure: The incisions are closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes 2 to 4 hours, depending on complexity.

Setting

Cranioplasty with autograft is usually performed in a hospital operating room.

Personnel

• Neurosurgeon or craniofacial surgeon
• Surgical nurses
• Anesthesiologist
• Possibly an orthopedic surgeon if bone harvesting is complex

Risks and Complications

• Infection
• Bleeding or hematoma
• Blood clots
• Graft rejection or resorption
• Anesthesia-related complications
• Neurological deficits

Benefits

• Protection of the brain
• Restoration of skull contour and aesthetics
• Potential improvement in neurological function Benefits can often be observed immediately or within a few weeks post-surgery.

Recovery

• Hospital stay of 2-5 days
• Pain management with prescribed medications
• Rest and limited activity for several weeks
• Follow-up appointments for suture removal and monitoring
• Avoidance of impact activities for several months

Alternatives

• Synthetic materials (e.g., titanium mesh, PMMA bone cement) for cranioplasty Pros: No need for donor site surgery and potential for reduced operative time. Cons: Higher risks of infection and long-term compatibility issues.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperatively, patients might experience swelling and discomfort at both the skull and donor sites, managed with pain medications. Recovery includes hospital rest and gradual return to normal activities, with close follow-up from the surgical team.