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Cranial Bones: Superior and Posterior View01:14

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The superior view of the cranium shows the frontal and paired parietal bones.
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
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Cranioplasty Following Decompressive Craniectomy.

Corrado Iaccarino1,2, Angelos G Kolias3,4, Louis-Georges Roumy5

  • 1Neurosurgery Unit, University Hospital of Parma, Parma, Italy.

Frontiers in Neurology
|February 18, 2020
PubMed
Summary

Cranioplasty (CP) after decompressive craniectomy (DC) restores function and protects the brain but carries risks. Optimal materials, timing, and hydrocephalus management for CP remain debated, especially in low-income countries.

Keywords:
bone flapcranial reconstructioncranioplastydecompressive craniectomyposttraumatic hydrocephalustraumatic brain injury

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Area of Science:

  • Neurosurgery
  • Traumatic Brain Injury (TBI) Management

Background:

  • Cranioplasty (CP) is a neurosurgical procedure following decompressive craniectomy (DC) for trauma.
  • It aims to restore cranial esthetics, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection, potentially aiding neurological recovery.
  • However, CP is associated with significant morbidity, and outcomes depend on surgical technique, materials, and timing.

Purpose of the Study:

  • To review the current evidence base for cranioplasty (CP) after decompressive craniectomy (DC).
  • To identify areas lacking consensus, including optimal materials, timing, and hydrocephalus management.
  • To highlight disparities in CP care between high-resource and low-income settings.

Main Methods:

  • This article is a narrative mini-review.
  • It discusses existing evidence on cranioplasty procedures, materials, and timing.
  • It also considers hydrocephalus management and resource limitations.

Main Results:

  • No consensus exists on the best materials for CP or the optimal timing post-DC.
  • Effective management of hydrocephalus in patients undergoing cranial reconstruction remains an open question.
  • Standardized CP care protocols are often inaccessible in low-income countries.

Conclusions:

  • Further prospective, context-specific studies are needed to establish evidence-based recommendations for CP.
  • Addressing disparities in care is crucial for improving outcomes in resource-limited settings.
  • Optimizing CP requires careful consideration of surgical factors, materials, timing, and patient-specific needs.