View of a 3D design of a custom-made implant to treat a hole in the skull

How to correct the cranial vault?

Certain changes to the cranial vault lead to irregularity or even loss of bone substance. The cause may be congenital, the result of an accident, or due to a surgical procedure (craniectomy).

It is possible to correct these deformations by installing a custom-made silicone elastomer 3D implant under the scalp, in order to remodel the skull (cranioplasty).

Cranial deformation

Image of a skull deformation visible under the skin

Cranial deformation may be of congenital origin or the result of an accident. It also often results from neurosurgical procedures requiring opening of the cranial vault in order to access the cortex, particularly for tumours.

It is not always possible to replace the cranial flap (infection), leaving the cerebral cortex exposed under the scalp. Even if it is replaced, a visible deformation may remain (sunken flap, flap atrophy, displaced flap - trepanning holes), which is difficult for the patient to accept.

 

3D Custom-made implant technique

Using a cephalic extremity CT scan of the patient, Anatomik Modeling creates a virtual copy of the skull, including the various anatomical frameworks of interest: scalp, cranial vault, cerebral cortex.

The implant is then designed virtually by computer in order to precisely correct the deformation or bone substance loss. Using a prototype, perfect copy of the implant, the Sebbin laboratory undertakes the final manufacture of the prosthesis in silicone rubber, following current ISO standards

Before and after image of a cranioplasty to correct a skull deformity

Cranioplasty and follow-up

Skull silicone implant to correct a cranial vault defect

Procedure

The scalp is opened, exposing the bony cranial vault, taking into account preexisting scars. Depending on the condition of the scalp in the area, it may be necessary to prepare a wide flap using expansion. The area of bone substance loss is prepared with removal of fibrous scar tissue and devitalised bone residue. The implant is then precisely positioned in the area of substance loss, with no dead space: it has no sutures or adhesive, but is stabilised by its shape and by being re-covered by the scalp. The procedure lasts around one hour.

View of the skull of a patient treated with a custom-made silicone implant

Post-operative course

There is little pain, with only simple analgesics (paracetamol) required. A standard dressing is applied, there is no risk of haematoma or serous effusion. Time off work is between 15 and 30 days, depending on size and depth of the substance loss.

 

Results

Custom-made technology can return a normal appearance to the shape of the skull.

Image of a skull deformation with holes
Image of a skull reconstructed by cranioplasty