Q: Dr. Eppley, I am interested in a reconstructive cranioplasty. I was involved in a car accident three years ago which resulted in me undergoing a craniotomy. They fitted titanium mesh to cover the area since the bone was crushed and couldn’t be sued.. As I have become older, I now see that the skull is indented over that area and therefore I wanna have a reconstructive cranioplasty. I have consulted with several neurosurgeons without much luck lately, because of concerns about further surgery.
Therefore I have a question related to cranioplasty. As I already have titanium mesh fitted, would it be a problem to remove that – does titanium mesh attach to the dura or tissue for that matter? That seems to be the question I can’t find a answer to, so hoping you can help me! Or would it be possible to just leave the mesh and cover the area with either PMMA filler or hydroxyapatite bone cement?
A: While it is possible to remove your titanium mesh in your reconstructive cranioplasty procedure and replace it with a custom implant, the risks of dural tears and a CSF leak is not worth that effort. It is far better to leave the mesh in place and cover it with any of the available bone cements of your choice.
Dr. Barry Eppley