Cranioplasty and the Post-Traumatic Syndrome

S INCE the beginning of World War II , there has developed a voluminous l i terature on cranioplasty. 1,2,3,4,6,s,9,1~ Mos t of these contributions deal with the use of tan ta lum to repair skull defects. In a search of recent and older l i terature on the subject, it is amazing to find how few of the articles make any reference to the indications for eranioplasty. Grant and Norcross 7 in their comprehensive s tudy state tha t one of the indications for cranioplasty is severe headache and other symptoms of the t rephined (dizziness, undue fatigability, vague discomfort at the site of the defect, a feeling of apprehension and insecurity, mental depression and intolerance to vibration). In the same paper they state tha t following skull repair the syndrome of the trephined is relieved in a large major i ty of cases. Interestingly, these same authors quote Tuffier and Guillain as concluding that skull repairs are useful only for cosmetic results. Woodhall and Spurling n in a recent article also list the syndrome of the trephined as an indication for performing eranioplasty. They state, however, tha t vertigo and generalized headache wi thout localized tenderness are less common complaints and appear unaffected by eranioplasty. They also are of the opinion that these complaints probably represent the sequelae of the cerebral injury. They noted tha t the complaint of local tenderness on palpation of the area of the defect was benefited by cranioplasty. GardneP believes the syndrome of the trephined would not be apt to occur if skull defects were repaired immediately. He states,