Reconstruction of Defects of the Cranial Vault

IntroductionThe cranial vault consists of 8 bones including paired parietal and temporal bones, the frontal bone, the squamous part of the occipital bone, the greater wings of the sphenoid bone and the ethmoid bone.These bones protect the brain.The calvarial growth ceases when the bones meet in the fusion area.Congenital defects include syndromic and non-syndromic.Acquired defects include defects from tumor, infection and trauma, which can cause loss of the calvarium due to direct trauma or by craniectomy procedure and may result in brain injury.The above defects, as well as tumor resections, bone flap infections, and pathological conditions (e.g.fibroosseous lesions, scleroderma, microphthalmia, or intracranial vascular lesions), can lead to post-traumatic residual defects to the frontal, parietal, temporal, and occipital bones 1-3 , as well as brain injury.In 1945, Gardner first mentioned the "syndrome of the trephined", which includes symptoms such as headache, dizziness, irritability, loss of concentration, depression, anxiety, intolerance to noise and vibration, and neuromotor weakness 4 .Similar symptoms were later described as "the sinking skin flap syndrome" 5 , caused by "the tenting effect", where, due to atmospheric pressure, the scalp "sinks" into the defect, shaped like a tent held by the defect's margins 6 .Reconstruction of these cranial defects has been attempted with the use of different materials in order to protect the brain and re-establish the continuity of the cranium.These materials can be autografts, allografts, xenografts and alloplastic materials 7 .The characteristics of an ideal material 8 are the following: 1) Biocompatibility: Non-toxic to the living tissue AbstractDefects of the cranial vault can be congenital or acquired.Congenital defects include syndromic and nonsyndromic.Acquired defects include defects from tumor, infection and trauma, which can cause loss of the calvarium due to direct trauma or by craniectomy procedure.The diagnostic approach for such cases includes physical examination and imaging techniques (such as plain radiographs, CT, MRI, and ultrasound).The method of reconstruction of cranial defects is tailor made to each individual patient.The method as well as the graft material is based on the patient's overall disease state, long-term prognosis, and medical comorbidities.Reconstruction of these cranial defects has been attempted with the use of different materials which include autografts, allografts, xenografts and alloplastic materials.The reconstruction of cranial defects requires a tailored approach based on the patient's overall disease state, long-term prognosis, and medical comorbidities.Autogenous grafts offer advantages such as integration, vascularity, and lower risk of infection, but have drawbacks including resorption.Allografts, xenografts and alloplastic biomaterials provide alternative options for reconstruction, but there is no ideal material that fulfils all characteristics.The choice of graft material should consider factors such as age, sex, size, and site of the defect.