Cranioplasty

What is a cranioplasty?

Cranioplasty refers to a surgical procedure to repair a defect in the skull. Your skull is the bone that surrounds and protects your brain. During a cranioplasty, a surgeon will:

• Replace part of your skull.
• Repair damage to your skull.
• Reshape (contour) your skull.

This type of surgery is common after:

• A traumatic head injury.
• A growth abnormality.
• Previous cranial surgery.

A cranioplasty is an elective procedure that may be required after some types of craniectomies or other forms of brain surgery. Your surgeon will let you know if you’re a candidate for a cranioplasty and when it’s safe to perform this procedure.

What does a cranioplasty treat?

A cranioplasty treats:

• Congenital conditions (birth defects).
• Damage following a traumatic injury.
• Skull shape irregularities (cosmetic defects).
• Areas of your skull where your brain may be vulnerable to injury.
• A defect (or hole) in your skull caused by previous surgery.

Is cranioplasty a major surgery?

A cranioplasty is a major surgery to repair your skull. There can be a moderate-to-high risk associated with this procedure, due to the location of the surgery in close proximity to your underlying brain.

How should I prepare for a cranioplasty?

Before a cranioplasty, you’ll meet with your surgeon who’ll go over your complete medical history and perform a physical exam. They’ll order tests to prepare for your surgery, which can include:

• Blood tests.
• X-ray.
• MRI.
• CT (computed tomography) scan.

Your surgeon will decide the best material to use in repairing your skull prior to surgery. Specialized imaging tests may be necessary to measure and create a prosthetic to exactly fit the skull defect or area requiring repair.

Your surgeon might recommend changes to your medication before your surgery. You may need to stop taking blood thinners if you take those regularly. Don’t stop taking medications unless your healthcare provider approves doing so. In addition, your surgeon may suggest you take antibiotics or anticonvulsants to reduce your risk of infection or complications from surgery.

If you smoke tobacco products or drink beverages that contain alcohol, you’ll need to reduce or stop using those products at least one week before surgery and for a couple of weeks after surgery, to prevent complications that can affect how your body heals.

What happens during a cranioplasty?

On the day of your surgery, you’ll receive anesthesia from an anesthesiologist, including medications to make you sleep and control pain.

In the operating room, your surgeon will:

• Shave any hair away from the incision site and superficially clean your skin.
• Make an incision into your skin. If you had a prior craniectomy, the incision will follow the same (or similar) line as your previous surgery.
• Carefully move tissue and muscle away to expose the region of your skull that needs attention.
• Repair your skull or replace a missing piece of your skull with either bone, a custom implant or some other material. Titanium plates and screws will secure these materials into place.
• Move your tissue and muscle back into place over the repaired piece of your skull.
• Close the incision in your skin.

What material does a surgeon use during a cranioplasty?

Your surgeon will use one of the following materials during a cranioplasty to repair your skull:

• A piece of your skull that a previous surgery removed.
• A bone from another part of your body (bone graft).
• Synthetic material that mimics your bone (calcium phosphate, hydroxyapatite).
• A metal (titanium) plate or mesh.
• A customized implant (polyetheretherketone or polymethyl methacrylate).

Your surgeon will choose a material that minimizes your risk of complications and that meets the needs of the procedure.

How long does a cranioplasty take?

A cranioplasty usually lasts up to three hours. It may take longer depending on what your surgeon needs to do.

What can I expect after a cranioplasty?

After a cranioplasty, you’ll typically rest in a monitored unit (step-down unit) so your care team can watch your progress overnight. If there aren’t any complications, you’ll move to a regular hospital bed, where you may be monitored for up to five days, on average (or longer, if required).

You may feel pain, like a headache, after surgery. Your care team will give you medications to ease your pain and make you more comfortable. It’s also important that you rest with your head elevated and supported with pillows.

Before you leave the hospital, you’ll get imaging tests of your head to make sure everything is healing as expected. Your surgeon will give you specific instructions on how to take care of yourself after surgery once you leave the hospital. You should avoid strenuous activities and get plenty of rest. Don’t drive until your healthcare provider says you can do so.

What are the benefits of a cranioplasty?

Some of the important benefits of a cranioplasty are:

• It reshapes your head.
• It protects your brain.
• It fixes dimpling after craniectomy.
• It reduces headaches.
• It can improve brain function.

What are the complications of a cranioplasty?

Studies show that there’s nearly a 40% chance of a risk or complication following a cranioplasty procedure. Your chance of complications developing after surgery varies based on what your surgeon needed to fix and your general health. The most common complications after a cranioplasty are:

• Infection.
• Blood clot.
• Brain injury/damage.
• Pneumonia.

Complications that can be life-threatening after cranioplasty include:

• Hydrocephalus.
• Seizure.
• Stroke.

What is the recovery time for a cranioplasty?

Your recovery time varies based on the extent and reason for your surgery. It usually takes between one and three months to recover from cranioplasty. Talk to your healthcare provider for more information on your recovery time.

When will I need follow-up appointments after a cranioplasty?

Your healthcare provider will schedule follow-up appointments for several weeks after your surgery. The usual schedule of appointments is after one week, one month and at three months. Additional visits to see your healthcare provider may be necessary if you experience any complications after surgery, like an infection. You may need to participate in rehabilitation during your recovery.

When should I call my healthcare provider?

Contact your healthcare provider if you have:

• Severe headaches that don’t go away.
• Fever.
• Swelling.
• Fluid leaking from your surgical site.

Contact local emergency services or 911 if you have a seizure or signs of a stroke.

A note from Cleveland Clinic

You may need a cranioplasty after a craniectomy or a traumatic injury. You may feel a variety of emotions preparing for a second surgery to repair your skull after brain surgery or following a head injury. While there are risks associated with this type of surgery, they’re treatable when detected early. Talk to your surgeon about the procedure and what to expect as you recover. You’ll meet with your care team often for follow-up appointments and rehabilitation, so you can feel better sooner.