Posts Tagged ‘cranioplasty’
Wednesday, May 1st, 2013
Q: Dr. Eppley, Wow. Information about dents on a persons head is next to impossible to find on the internet. I have about dent on the very top of my head that is about 2 inches in diameter, so it is a fairly large dent. After an accident, some skin was literally ripped from the top of my skull. Eventually, the skin did grow back, but I have no hair there now as the hair follicles went with the skin when it was ripped from my skull. The main problem is though I have a dent in my head there too. At first I thought that all the tissue ( the matter under the skin ) didn’t grow back even though the skin did. Recently, a CT scan showed that part of my skull was thin, so now I don’t know if I have the dent because I need tissue or if it’s because of my skull. Is there any way to determine what the actual cause of this dent is, and if it’s the skull, would anything procedure done to the skull raise the tissue so that it is flush with the rest of my head?
A: While I don’t know the details of your original injury, it strikes me as unlikely that you would have pushed in your skull or removed the outer layer of cranial bone with an avulsion type injury. My suspicion is that this is more of soft tissue defect than bone. the scalp is incredibly thick in many patients particularly of your ethnicity. If you lost enough scalp to remove the hair what is healed is now a partial thickness of scalp which can certainly create an ‘indentation’. The definitive answer, however, would be the CT scan which should clearly show what the bone looks like underneath of the scalp…if the scan was done using coronal images and not just axial slices. I would need to see the the scan and pictures of your scalp defect to definitively determine the anatomic basis of your head indentation.
If it is just soft tissue you can have the defect excised and the hair-bearing scalp defect loosened and used to repair the defect. If there is a loss of bone component to it this can be simply filled in with hydroxyapatite cement (cranioplasty) and the hair-bearing scalp tissue closed over it.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cranioplasty, dr barry eppley, head dent repair, indianapolis, skull reshaping
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Tuesday, March 5th, 2013
Q: Dr.
Eppley, I am interested in skull augmentation. I have heard of Osteobond being used overseas. Is an expander needed? I have a normal shape, just want to make it larger. What is the estimated cost? Thank you, I appreciate your time.
A: Whether an expander is needed for skull augmentation depends on how much skull expansion is desired and where that expansion on the skull is needed. Please send me some pictures so I can do imaging to get a feel if yours is a one-stage or two-stage skull augmentation. Knowing that and the material used plays a major role in the cost of the procedure.
Osteobond is not an FDA-approved cranioplasty material in theU.S. The approved options here are polymethylmethacrylate (PMMA, Cranioplast) and hydroxyapatite (HA, Mimix and others).
Dr. Barry Eppley
Indianapolis,Indiana
Tags: cranioplasty, dr barry eppley, indianapolis, skull augmentation, skull reshaping
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Saturday, February 23rd, 2013
Q: Dr. Eppley, I have some questions regarding cranioplasty, rhinoplasty, and septoplasty. I have a form of craniosyntosis and my skull has indentations that could be improved by a cranioplasty, I also have a severe deviated septum and crooked nose that needs correcting by having a combination of rhino/septoplasty. Insurance will cover the procedures for my nose to get corrected. I believe I have seen somewhere on your website where someone asked a question similar to this, and you said something along the lines of
it is ideal to get the cranioplasty and rhino/septoplasty all done at once. That probably is not a possibility in my case, because getting my insurance to cover the cranioplasty is going to be difficult, so I am going to have to put that off for now until I have the money to get it done.
My questions are:
1.Would it be OK to get rhinoplasty/septoplasty done before getting a cranioplasty?
2.Or is it better to get the cranioplasty done first?
3.Or does it not matter at all in which order I get these procedures done?
Thanks
A: In answer to your questions:
1) Insurance may cover the septoplasty portion of your nasal deformity but not the rhinoplasty portion.
2) Insurance will not cover any type of cranioplasty for skull recontouring. Indentations of the skull are not a medical condition but a cosmetic one.
3) The order of septorhinoplasty and cranioplasty is a matter of personal preference. There is no medical reason as to how they staged or in what order.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cranioplasty, dr barry eppley, indianapolis, rhinoplasty, septoplasty
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Monday, February 11th, 2013
Q: Dr. Eppley, I am looking at building up the back of my head. In reading your blogs you say that you usually add about 60 grams of material. But I don’t know how that would look and whether that is enough. I went on with my experiments, but rather than water I used plasticine which conveniently has a density close to PMMA, to check the volume. I adapted it to the back of my head like an implant would be, and as you said the change is bigger than one would expect (I tried 60g and 80g). So if the trade-off for a bigger volume is ‘longer or more full coronal incision’, could you tell me what would be its size and location for 60g and 80g? (I’m not sure I’ve read around 10 centimeters for 60g on your blog) As a side question, how would you attach the implant to my skull?
A: That is a clever way to see how much volume 60 grams of cranioplasty material is. Remember that it will also look bigger than you think when placed under the scalp skin. To get this amount of material on the back of the skull, an incision of 14 to 16cms long is usually needed. Onlay cranioplasty materials are fixed to the skull by first applying small screws to the skull bone allowing them to set up about 3 or 4mms above the bone. When the material is then applied this gives it something to hang onto to like rebar used in concrete. While screw fixation may not be absolutely necessary for augmentative skull reshaping, I prefer it since it is simple to do and adds a bit of security for prevention of implant mobility.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: cranioplasty, dr barry eppley, indianapolis, skull reshaping
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Monday, January 28th, 2013
Q: Dr. Eppley, I have contacted you in the past about questions I had regarding indentations I have on my skull, and about fixing them with a cranioplasty. You responded by telling me that I would require an open approach cranioplasty and the incision would be bilateral from ear to ear. Along with having a large indentations on my skull, I also am going bald. I am interested in getting a cranioplasty done by you and also am planning on getting a FUE hair restoration at some point.
My questions are:
1. If I was to get a FUE hair transplant/restoration would it be better to do it before or after the cranioplasty?
2. Would it make sense to do it after, so it mite be able to help cover the scar? or does it even matter?
3. Also can you diagnose what the name of the medical term/condition is that I have wrong with my skull by looking at the attached pictures I have here?
A: In answer to your questions, you would always want to do hair tranplantation AFTER a cranioplasty. This is because it would also give one the opportunity to place hair grafts along the scar should that be necessary. While this could always be done after, you would like to have that option during the initial FUE procedure. Usually that is not necessary but it is a theoretical option that you want to keep available given that bothi of these procedures are elective and can be done anytime in any order.
I believe what you have is a very incomplete form (microform expression) of bicoronal craniosynostosis. This is because you have deep indentations (like a constricting band) right along the exact location of the underlying original coronal suture locations.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: cranioplasty, dr barry eppley, hair transplants, indianapolis, skull reshaping
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Sunday, December 2nd, 2012
Q: Dr. Eppley, I am inquiring about a natural method for cranioplasty. I have a forehead defect including a hole through the bone from a prior craniotomy for a brain tumor. The size of the forehead defect measures about 9 x 2 cms and represents the area where the bone flap appears to have settled inward. Can I use my own bone to reconstruct this forehead defect area?
A: Cranial bone flaps, despite using rigid fixation, can heal inconsistently or undergo some resorption leaving an outer contour depression. There are multiple ways to do a cosmetic or reconstructive cranioplasty with a variety of materials, bone being one of the options. If the defect is small enough, one could use natural bone, in other words cranial bone grafts. While natural bone has understandable appeal, it is actually not the best way to do most cranioplasties. B
esides having to harvest the bone (and creating another bone defect), bone grafts are notoriously unreliable and predisposed to incomplete or total bone resorption particularly when used as an onlay. The more reliable way to perform most cranioplasties is to use hydroxyapatite cements. They are structurally stable, do not resorb and can be shaped perfectly to any defect whether it is an inlay, onlay or a combined cranial defect. They are also composed of hydroxyapatite, a calcium phosphate mineral, which is highly biocompatible with natural bone. While bone will never truly grow into it and replace it, bone will bond directly to it. The type of forehead defect that you have would do well with a hydroxyapatite cement cranioplasty.
Dr. Barry Eppley
Indianapolis, Indiana
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Tags: cranial bone grafts, cranioplasty, dr barry eppley, hydroxyapatite cement, indianapolis
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Friday, November 30th, 2012
Q: Dr. Eppley, My question is about the appropriate age for my son’s skull surgery. I wasnt to get the flat back of his head fixed by an onlay cranioplasty procedure that you have described. He is now 18 months old. Should I wait until my son is older?
A: There is no right or wrong answer to that timing of surgery question. Such 'cosmetic' skull surgery in a child is unique because they are not in a position to pass judgment about the value/benefits of the procedure. (and they won't be for a long time) Thus it requires the parents to determine the m
erits of the skull reshaping procedure as they look at the child's long lifespan and their psychosocial development. While that is not that helpful, you have to look at the magnitude of the skull deformity and determine if improving it early justifies surgery. It can be done at anytime as age is not a criteria (beyond 18 to 24 months old) for the surgery. You just want to be sure that the deformity has no chance to improve on its own with future skull growth.
Dr. Barry Eppley
Indianapolis, Indiana
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Tags: cranioplasty, dr barry eppley, indianapolis, infant skull reshaping
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Wednesday, September 12th, 2012
Q: Dr. Eppley, my son is 5 years old and has undergone a craniectomy of the right parietal skull bone which is quite large when he was 4 years old. We want to know which cranioplasty procedure would be best for him, bone cement or autologous bone transplant from the adjacent side of the skull? He is otherwise neurologically fine with no functional or developmental deficits.
A: To give a very specific answer as it relates to your son, I would need to know some more information about his defect including reviewing a CT scan and see pictures of him. But I can make some general comments about skull reconstruction in children. When you have large skull defects in young children, the reconstuction options are somewhat more limited because you really don’t have the ability to use a cranial bone graft. While a cranial bone graft, what you call an autologous bone transplant, can be done you essentially would be ‘robbing Peter to pay Paul’ do to speak. In children the skull is not think enough to harvest a split-thickness cranial graft. This using a cranial bone graft just creates the same problem you are trying to solve somewhere else. Thus one is forced to use a variety of synthetic methods for the skull reconstruction. These could include bone cements (resorbable and non-resorbable), metal meshes (one I wouldn’t do), and a assortment of synthetic implant material that are either preformed or custom-made from a CT scan. (e.g., HTR-PMI) There are advantages and disadvantages to all of these synthetic approaches and that needs to be discussed on an individual case basis.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cranioplasty, dr barry eppley, indianapolis, skull reconstruction
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Monday, August 20th, 2012
Q: Dr. Eppley, how much does cranioplasty cost, ranging from the lowest to the highest cost? In addition, can you make my eyelashes and eyebrows thicker by doing hair transplants?
A: In answer to your questions:
1) The cost of cranioplasty can vary significantly based on what type and size of skull problem is being treated and what meterial may be used if augmentation is being done. But for the sake of some general cost ranges, it can vary from $6500 to $15,000. To better answer your question, I would need to know more specifics as to your skull concerns.
2) Eyebrows can be thickened with hair tranplantation techniques. The use of single follicle transplants are used with anywhere from 50 to 200 eyebrows needed per brow.
3) Eyelashes are best thickened and lengthened with the use of the topical drug, Latisse. This popular drug is well known to increase lash length by 30%, thicken the shafts by 30% and make them grow faster. Essentially, Latisse for eyelashes is like Rogaine for scalp hair. If one has no eyelashes at all, hair transplants can be done but it rare to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cranioplasty, dr barry eppley, eyebrow hair tranplants, indianapolis
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Friday, August 17th, 2012
Q: Dr. Eppley, I have few questions about cranioplasty for my infant son.
1) I’ve read when it comes to cranioplasty, if done correctly and of course by the right surgeon, the scar would be generally “fine” not thick and the hair would eventually regrow on the scar after healthy healing, any truth to this theory?
2) If my recollection serves me correctly, I read when you inserted Kryptonite it was basically sort of like rolling the dice for the most part, because you didn’t EXACTLY know how it was going to turn out. It was basically a wait and see approach. Is it like this with the approach of inserting material in the skull? Or you pretty much have a good general idea by measuring and/or imaging of what it’s possibly going to look like before the surgery?
3) Since my son needs augmenting on the top of his head (right side) to correct/improve the head height differential, and also needs the reconstructing of his parietal bone, can this be done with one incision? Or you need 2 incisions?
4) For cranioplasty the scar will be approx. 4 inches correct (give or take)?
A: You have wisely and correctly interpreted what you have read. All four assumptions are correct.
1) Scalp scars in infants tend to be very fine. I would not always assume that hair will growth through the scar however.
2) Open cranioplasties do not generally have the contour/smoothness issues that are associated with an injectable approach because you can see what you are doing.
3) Only one incision would be needed.
4) The scalp scars are generally not longer than 8 to 10 cms.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cranioplasty, dr barry eppley, indianapolis, skull reshaping
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