What Is The Process In Getting A Custom Skull Implant?

Q: Dr. Eppley, I am interested in getting a custom skull implant made for the back of head to correct its flatness. But I have some basic questions if you don’t mind about the process and how it all works as well as some question about the surgery itself.

1) How many times do we physically have to meet? How many trips will I have to take to your office?

2) My biggest concern is that the implant has be made exactly to the specifications and contours of my sKull so that there are no “pockets” between my skull or the implant (no matter how small or microscopic, i don’t want to risk complications) I want it to fit “like a glove.” Will the implant be custom made at the time me meet? After? Will I have time to see and try the implant, (meaning see how it fits on the back of my head by actually applying it on my head externally?)  How will I know what the final result will look like? How accurate are the computer models?

3) How are the implants designed? Can you tell me more about the process and steps? I.e: we meet, you take measurements of my head, look at CT scans, and send info out to the lab where its made? What is the actual process from the moment I agree to surgery 

4) What complications (if any) have you had in the past with surgery of this nature? How many patients needed revision or had complications? 

5) What are the risks or side effects post op? What should I expect? How long is recovery and healing time? How long does it take for the scar to heal, or for any swelling to go down? Is there a high risk of infection?

A: In answer to your questions about a custom skull implant:

1) The only times we really have to meet is the day before surgery when you come for your surgery. Any followups are done by phone or Skype.

2) The implant will be made off of your 3D CT scan (which you can get in your local community). It is made by a computer design process to the dimensions that I provide. This way it will fit perfectly, like a cap on a prepared tooth. This is all done before surgery and does not require you to be seen. During the design process I will provide with the PDF files so you can see exactly what the implant looks like and its size. This process takes about 3 weeks to make once they (Medical Modeling, Golden Colorado) get the CT scan.

3) As above. It all starts with you getting a 3D CT Skull scan.

4) I have done many custom implants and skull augmentation with implants and bone cements. The only problems that I have seen are aesthetic…was it big enough? was it smooth and symmetric? My experience shows about a 10% risk of a revisional surgery for some aesthetic adjustment. In the case of a computer-generated skull implant, the computer design process helps avoid most of these aesthetic issues. I have yet to see an infection or any significant wound healing problem.

5) Other than some swelling, most patients do not have much pain. There are no restrictions after surgery and one can return to any activity as soon as they feel like they can. The incision heals very quickly and, even with swelling, most people don’t even notice it since the head shape just becomes more normal. In rare cases, some swelling may go forward to the eyes but that depends on how much scalp dissection is needed.

Dr. Barry Eppley

Indianapolis, Indiana