12 Cranioplasty



10.1055/b-0040-176501

12 Cranioplasty

Ryan F. Amidon, Christ Ordookhanian, and Paul E. Kaloostian

12.1 Symptoms and Signs




  • State of confusion



  • Headache



  • Vomiting or nausea



  • Fatigue



  • Difficulty producing speech



  • Abnormal sleeping behavior



  • Difficulty maintaining balance



  • Blurred vision, abnormal taste/smell senses



  • Mood change



  • Memory or concentration deficiency



  • Depression or anxiety



  • Pupil dilation



  • Weakness/Numbness in fingers/toes



  • Coma



  • Neurologic dysfunction from cranial nerve damage



12.2 Surgical Pathology




  • Cranial benign/malignant trauma



12.3 Diagnostic Modalities




  • Physical examination



  • Neurological examination



  • Glasgow Coma Scale



  • CT scan of brain without contrast (see ▶Fig. 12.1)

    Fig. 12.1 Preoperative CT scan revealed intracranial trauma and trajectory of left frontal gunshot wound in a 4-year-old child (a). Decompression and superficial fragment evacuation were performed via cranioplasty (b). Follow-up three-dimensional computed tomography (3D-CT; 6 months) (c). Operative detail and preparation. In: Cohen A, ed. Pediatric Neurosurgery. 1st ed. Thieme; 2015


  • MRI of brain without contrast



  • X-ray of brain (test for skull fractures)



12.4 Differential Diagnosis




  • Diffuse axonal injury (DAI)



  • Concussion



  • Contusion



  • Coup/Contrecoup lesion



  • Skull fracture



  • Hematoma




    • Epidural hematoma (bleeding between skull and dura mater)



    • Subdural hematoma (bleeding between dura and arachnoid mater)



    • Subarachnoid hemorrhage (bleeding between arachnoid mater and pia mater)



    • Intracerebral hematoma (bleeding into brain itself)



  • Degenerative brain disease from repeated or severe traumatic brain injury (TBI)




    • Alzheimer’s disease



    • Parkinson’s disease



    • Dementia pugilistica

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11 Hemicraniectomy (Unilateral, Bilateral, Bifrontal versus Frontotemporal) 10 Epidural Hematoma Evacuation/Subdural Hematoma Evacuation/Intracerebral Hemorrhage Evacuation 13 Placement of External Ventricular Drain/Placement of Intraparenchymal ICP Monitor 6 Spinal Radiosurgery 16 Amygdalohippocampectomy 22 Ventriculoatrial Shunt

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May 15, 2020 | Posted by in NEUROSURGERY | Comments Off on 12 Cranioplasty

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