Aesthetic issues in neurosurgery: a protocol to improve cosmetic outcome in cranial surgery

Nowadays, surgical interventions must treat with care the aesthetic impact on the patient, even when a malignant pathology or an patient's advanced age could give the aesthetic issue lower priority. The cranio-facial area is probably the most important anatomical region with regard to the harmony of the human body. Consequently, a step-by-step procedure, applicable regardless of the site and the nature of the lesion, is advisable to minimize the aesthetic impact. We prospectively analyzed 65 patients during a period of 2 years. At 1-year follow-up, all patients were invited to undergo a 3D-multislice CT and to complete a questionnaire with a subjective rating scale about aesthetic impact. The 3D-multislice CT scan didn't show dislocations, depressions or gaps of the bone flap. Nevertheless, five patients complained of some degree of aesthetic injury, or reported a psychological suffering from the aesthetic consequences of surgery. As a control group, we retrospectively reviewed 223 patients. The authors describe their surgical protocol and discuss it in the light of the results of their series.