A craniectomy is a neurosurgical procedure involving the temporary removal of a portion of the skull to address serious conditions affecting the brain. This article will explore what happens to the removed skull bone, the reasons behind this temporary approach, and the journey of recovery for patients undergoing such a procedure.
What is a Craniectomy
A craniectomy is a surgical intervention performed to alleviate dangerous pressure or swelling within the brain. It is commonly employed in situations such as traumatic brain injury, stroke, or severe infections that cause brain swelling. Unlike a craniotomy, where the removed skull bone is immediately replaced, a craniectomy leaves an opening in the skull. This allows the swollen brain space to expand, preventing further damage from compression against the rigid skull. The objective is to reduce intracranial pressure, which, if left unmanaged, can lead to permanent brain damage or be life-threatening.
Temporary Skull Removal
The skull bone is not immediately re-attached after a craniectomy to accommodate ongoing brain swelling. Re-attaching the bone too soon could compromise brain recovery. This temporary removal also reduces infection risk and prevents further damage to brain tissue. The removed skull piece, called a bone flap, requires careful storage until brain swelling subsides and it can be re-implanted.
Two methods are used for temporary bone flap storage. One method is subcutaneous autologous storage, where the patient’s bone is placed under the skin, typically in the abdomen or thigh. This approach leverages the body’s natural environment, reducing rejection risk and offering a biologically compatible option. While advantageous for natural integration and lower cost, considerations include infection risk at the storage site or changes in bone structure over time.
The second method is cryopreservation, storing the bone flap in a specialized freezer, or bone bank. After removal, the bone is cleaned, sterilized, and packaged in sterile conditions before freezing at -18°C to -83°C. This sterile environment minimizes infection risk and avoids a second surgical site. Logistical considerations include bone bank maintenance costs and the need to culture the bone flap for microorganisms before re-implantation.
The Return of the Skull
Once brain swelling resolves and the patient’s condition stabilizes, a cranioplasty is performed to re-implant the stored bone flap. Cranioplasty restores skull integrity, protects the brain, improves cosmetic appearance, and can improve neurological function. The procedure involves retrieving the bone flap from its temporary storage, preparing it, and surgically re-attaching it to the skull using small plates and screws.
The timeline for cranioplasty can vary, typically occurring several weeks to months after the initial craniectomy, allowing sufficient time for brain recovery. If the original bone flap cannot be used due to infection, damage, or other issues, surgeons can utilize alternative materials. These alternatives may include synthetic implants or custom prosthetics, often made from materials like titanium or various polymers, designed to precisely fit the cranial defect. The goal remains to restore the skull’s protective barrier and improve the patient’s overall well-being.
Life After Craniectomy
Patients navigate a distinct recovery journey both with a missing bone flap and after its return. While the skull is open, patients often wear a protective helmet to shield their brain from trauma. Precautions include avoiding activities that could lead to head injury and limiting strenuous physical exertion. Some individuals may experience dizziness or balance issues, which improve once the skull is reconstructed.
Following cranioplasty, the healing process continues as the bone flap integrates or the synthetic implant stabilizes. Patients may experience fatigue, headaches, and swelling around the surgical site as they recover. Rehabilitation, which might include physical, occupational, and speech therapy, often plays a role in regaining lost functions and adapting to new routines. The psychological impact of living with a temporary skull defect and undergoing multiple surgeries can be significant, making emotional support and ongoing medical follow-up important aspects of comprehensive care.