Subtotal Reconstruction of the Cranial Vault: Case Report and Technical Considerations in Planning and Finalizing Custom-Made Undercorrected Cranioplasty

Gabriele G, Benedetti S, Cascino F, di Pietro G and Gennaro P

Department of Maxillo-Facial Surgery, Le Scotte University Hospital of Siena, Italy
Department of Neurosurgery, S. Maria alle Scotte University Hospital, Italy

^*Correspondance to: Simone Benedetti 

 PDF  Full Text Case Report | Open Access

Abstract:

Introduction: The aim of this report is to introduce the concept of undercorrection in CAD-CAM cranioplasty in the context of patients who underwent subtotal Decompressive Craniotomy (DC). Case Report: A case of a young patient, who underwent bilateral post-traumatic DC of 40% of the cranial vault and successive custom-made cranioplasty, is reported in this article. The patient’s case was studied 13 months after DC through high-resolution CT, assessing brain, skull and scalp data, that were used for virtual Three-Dimensional (3D) analysis and planning, in order to produce hypoprojected PEEK implants that prevented both an excessive tension on the severely scarred scalp and an excessive intracranial dead space. The patient was treated with a one-stage cranioplasty that reconstructed 208 cm2 of the cranial vault while obtaining tensionless scalp closure; a total of 46 cm2 of skull surface in the lower temporal areas were left unreconstructed as they could work as a warning sign for the rise of ICP in case of swelling. The 12-months follow-up showed satisfactory aesthetic and structural results. Discussion: Whether it’s for treatment of the syndrome of the trephined or for aesthetic purposes, the need to reconstruct calvarial defects remains a challenge, especially for very large defects (>150 cm2) which are rarely described in literature. To overcome the potential intra- and extracranial complications to the procedure, available surface-guided CAD-CAM programming represents an optimal solution. Conclusion: In this report, use of undercorrection in planning and finalizing subtotal custom-made cranioplasty, appears able to restore skull integrity and aesthetics while avoiding excessive skin tension and reducing intracranial dead space.

Keywords:

Cranioplasty; Subtotal cranioplasty; Custom-made cranioplasty; Decompressive craniectomy; Traumatic brain injury

Cite the Article:

Gabriele G, Benedetti S, Cascino F, di Pietro G, Gennaro P. Subtotal Reconstruction of the Cranial Vault: Case Report and Technical Considerations in Planning and Finalizing Custom-Made Undercorrected Cranioplasty. Clin Case Rep Int. 2023; 7: 1547.