[Cranioplasty with titanium plate. Report of 114 cases]

Pinwheel-Shaped Titanium Plates Should Be Fixed to the Skull Using All Screw Holes to Protect the Plates from Being Bent

Introduction

In cranioplasty, pinwheel-shaped titanium mini plates are frequently used to cover bone defects produced by burr holes, and it is common to insert screws through only a few of the holes in cranial flap fixation.

Presentation of Case

A 69-year-old man who had undergone clipping surgery for subarachnoid hemorrhage 16 years previously visited our clinic because a titanium plate had penetrated his scalp one month after he was hit on the head by a wall cabinet. Imaging studies revealed that part of the titanium plate had bent outwards and penetrated the skin. The plate was surgically removed, a relief skin incision was made 6 cm posterior to the skin defect to suture the defected portion without causing tension, and a skin graft was applied to the relief skin incision portion. Two months after the maneuver, the skin graft had been successfully incorporated without infection.

Discussion

Even after the subcutaneous and the cutaneous tissue have completely covered the pinwheel-shaped titanium mini plate, an edge without screw fixation can be easily bent by a hard blow to the overlying scalp. We recommend fixation of pinwheel-shaped titanium plates used in cranioplasty through all screw holes to protect against the plate being bent.

Exposure of Titanium Mesh after Cranioplasty for Microvascular Decompression Surgery: Two Case Reports

Two cases of exposed titanium mesh occurred after implantation for cranioplasty after repeated procedures for microvascular decompression (MVD). Case 1 was a 62-year-old female who underwent MVD for left hemifacial spasm followed by repair of cerebrospinal fluid leak after the surgery, and Case 2 was a 75-year-old female who underwent MVD twice for right trigeminal neuralgia. Both patients visited our hospital again with complaints of postauricular lesion. Titanium mesh was visible through the operative scar and was successfully removed with no complication in both cases. Both patients were underweight females, and combined with multistep surgery may have contributed to the pathology. The present cases suggest that use of titanium mesh should be avoided for cranioplasty of posterior fossa surgery, especially for repeated procedures.

In situcranioplasty with methylmethacrylate and wire lattice

Most techniques of cranioplasty are expensive and require advance preparation if a custom-moulded prosthesis is to be used. Technical problems with cranioplasties using synthetic materials include sinking, elevation and rotation, while those with hydroxyapatite or bone graft cranioplasties include resorption and harvest site disfigurement. We report our technique of in situ cranioplasty using methylmethacrylate and a wire lattice that is fast, inexpensive and avoids these technical problems.