Skull Reconstruction Helps With Deformities

After tumors or accidents, the skull may be so damaged that a helmet is required to protect the brain because few other options are available. Now a new surgical technique provides complex skull reconstruction.

The first such surgery was completed at Massachusetts General Hospital after a middle-aged man underwent an operation to remove a brain tumor. A severe bone infection later meant that doctors were forced to remove part of his skull.

There is hope for patients with skull deformities.

Because he was left with a severe skull deformity, he was required to wear a helmet daily to protect his exposed brain from further injury. However, during the time it took for the infection to clear, he was left with a significant skull deformity where his brain had expanded outside the bounds of his skull, making traditional reconstructive surgery impossible.

This prompted plastic surgeons to develop a method for reconstructing the skull in cases where it was previously not possible. The patient was the first to benefit from the new technique in which the outer lining of the brain is reshaped before surgeons reconstruct the skull with metal and acrylic.

Dr. Chad R. Gordon, now assistant professor in the department of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine and former Massachusetts General Hospital associate staff member and craniomaxillofacial fellow at Harvard Medical School, said that up until now skull construction options in difficult cases had been limited, leaving many patients with skull deformities because of unforeseen circumstances.

The approach called bipolar duraplasty uses low-level heat to precisely and instantly shrink the brain, which allows the skull to then be reconstructed. It provides permanent brain protection and a better aesthetic appearance for the patient.

This marks the first instance that the surgery has been performed. The patient has reported no complications in the year following his operation. Dr. Gordon hopes to conduct a future clinical trial to evaluate the long-term outcomes in patients with similar skull deformities.

Details of the procedure were published in The Journal of Neurosurgery.