Can You Answer Some Questions About Cranioplasty For The Flat Back Of My Head?
Q: Dr. Eppley, I have a few questions about building out a flat spot on my skull. I have attached some pictures for your evaluation. My questions are:
1) Since the Kryptonite material is no more available there is only the PMMA,Hydroxyalite(HA) and custom silicone implant available. If I understand well all these materials are requiring an open approach under general anesthesia for two hours
and they all leave a scar between 8-10cm when they are introduced under the scalp. Will the scar be visible if i keep my hair a little longer then short?
2) Other than a scar ,minor contour issues remain as the only risk. If these contour issues ever occur later after surgery, what have to be done and how?
3) Hydroxyapatite material bonds to the bone with no risk of osteolysis. Does it make then (HA) safer than PMMA in that matter?
4)What is the biggest disadvantage in using hydroxyapatite material?
5) The safety is my biggest concern long after the surgery, which of these materials are best proven over the years?
6) I would be traveling from abroad. How long do I have to stay in the U.S. and do I need some special medical insurance in case something goes wrong during the surgery.
A: Based on your photos, what I see you are demonstrating is a severe flatness to the back of the head, lack of occipital projection. In answer to your questions:
1) The posterior scalp scar is about 8 to 10 cms that with hair will remain hidden. There are numerous bald.shaved patients who have the procedure as well but I think it is a good idea to be well aware of the scar potential.
2) If any contour issue arises, such as an edge than one can feel or some asymmetry, it can be easily adjusted/fixed through the same scar approach. I go to great lengths to avoid that happening for the obvious reason…no patient wants to go back to surgery. But despite my best efforts, surgery is not always perfect.
3) HA does have a direct bone to bone so, in theory, it is a more biocompatible material. I wouldn’t use the word safer as both materials have been used successfully for decades. But if I was a young person and had a choice between the two materials (cost is the big issue) then I would go with HA>
4) Cost is the only disadvantage to the HA material. By volume alone, it takes twice as much HSA to get the same volume effect as PMMA>
5) PMMA has been used as a cranioplasty material for over 40 years. HA has been used for over 25 years.
6) Almost all cranioplasty patients return home within 48 hours after surgery. No special medical insurance is needed as nothing is going to go wrong that would warrant any catastrophic medical care. This is the simple addition of a material on the outside of the skull bones, it is very safe. The risks of this surgery are aesthetic concerns not significant medical complications.
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.