Calvarial Reconstruction

Abstract

Calvarial reconstruction is a challenge to reconstructive surgeons, especially considering protection of intracranial contents. In recent years, the advent of multiple reconstructive materials adds tools to the surgical armamentarium. Options include autologous split calvarial and rib grafts and alloplastic materials such as titanium mesh, methyl methacrylate, calcium hydroxyapatite, and polyetheretherketone. The most important aspect of cranial reconstruction still lies in finding the most aesthetic, safe, and reliable means of filling a defect.

Management of Skull Fractures and Calvarial Defects

“…Reconstruction of calvarial defects has two main goals: (1) restoration of a barrier between cranial contents and external elements and (2) cosmetic restoration of the contour of the skull and its overlying tissue. 5 Recreation of the calvarial barrier has been shown to improve CSF dynamics. 6,7 Furthermore, inadequate functional closure and repair is associated with persistent headaches, fatigue, dizziness, and psychological distress.…”

“…6,7 Furthermore, inadequate functional closure and repair is associated with persistent headaches, fatigue, dizziness, and psychological distress. 5 There are many materials that can be used for successful cranial reconstruction, both autologous and synthetic. The ideal material is strong enough to protect intracranial contents, malleable to recreate the natural contour of the skull, relatively lightweight, and capable of osseous integration with native calvarium.…”

“…In case infection is present, autologous bone can be salvaged through debridement, whereas synthetic grafts would require complete removal and replacement. 5 Disadvantages of autologous bone include donor-site morbidity. 5 Care must be taken when harvesting a splitcalvarial graft not to damage the inner table or sagittal sinus.…”

“…5 Disadvantages of autologous bone include donor-site morbidity. 5 Care must be taken when harvesting a splitcalvarial graft not to damage the inner table or sagittal sinus. In some cases, a full-thickness craniotomy can be created, the harvested bone split into inner and outer tables after harvest, and then the donor site reconstructed with the inner table at the same time the outer table is used for a different site.…”

“…Common synthetics used for calvarial reconstruction today include titanium mesh, polymethylmethacrylate (PMMA), hydroxylapatite, and polyetheretherketone (PEEK). 5…”