62147 Cranioplasty with autograft (includes obtaining bone grafts); larger than 5 cm diameter

Name of the Procedure:

Cranioplasty with Autograft (includes obtaining bone grafts); larger than 5 cm diameter.

Summary

Cranioplasty with autograft is a surgical procedure to repair defects in the skull larger than 5 cm using the patient's own bone. This reconstruction helps protect the brain and restore the skull's natural shape.

Purpose

This procedure addresses defects or deformities in the skull caused by trauma, surgery, or congenital conditions. The goal is to protect the brain, restore the aesthetic appearance of the skull, and improve the patient's overall cranial function.

Indications

• Significant skull defects larger than 5 cm.
• Post-surgical reconstruction following tumor removal.
• Skull fractures that have not healed properly.
• Congenital skull deformities.

Preparation

• Patients may need to fast for 8-12 hours before surgery.
• Medication adjustments, including stopping blood thinners.
• Pre-operative imaging like CT scans or MRIs to map the defect.
• Blood tests and physical examination.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made over the defect site in the skull.
3. Bone graft is harvested, typically from another part of the patient's skull or occasionally from a different bone in the body.
4. The harvested bone is shaped to fit the defect precisely.
5. The bone graft is secured in place using plates, screws, or other fixation devices.
6. The scalp is sutured back in place over the repaired area.
7. The wound is dressed and bandaged to protect it and aid healing.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the defect.

Setting

Cranioplasty with autograft is performed in a hospital operating room.

Personnel

• Neurosurgeon or craniofacial surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technicians

Risks and Complications

• Infection
• Bleeding
• Bone graft rejection or resorption
• Neurological deficits
• Scarring
• Anesthesia-related risks
• Longer-term complications like graft displacement

Benefits

• Protection of the underlying brain tissue
• Cosmetic improvement of the skull's shape
• Restoration of skull integrity
• Potential improvement in neurological function

Recovery

• Hospital stay of 3-5 days post-surgery.
• Pain management includes medication and comfort measures.
• Instructions to keep the head elevated and avoid strenuous activity.
• Follow-up appointments to monitor healing and detect any complications early.
• Full recovery may take several weeks to months.

Alternatives

• Synthetic materials (e.g., titanium or polyetheretherketone plates)
  • Pros: No need for additional surgery to harvest bone.
  • Cons: Risk of infection, rejection, and may not integrate as well as natural bone.

Patient Experience

• The patient will be under general anesthesia during the surgery and won't feel anything.
• Post-operatively, there may be discomfort and swelling which can be managed with medication.
• Gradual improvement in appearance and function should be noticeable as healing progresses.