Management of extensive and difficult cranial defects

The procedure of split-skull cranioplasty was first investigated at the turn of the century. The present authors first reported their technique of split-skull cranioplasty in 1983, and describe here their experience with this procedure in the management of extensive and difficult cranial defects. Twenty-nine patients (11 females and 18 males) are reviewed. Ten patients had histories of infection before reconstruction surgery. Eleven patients received radiation therapy at the grafted areas. The postoperative follow-up period ranged from 6 months to 4 1/2 years. There was no evidence of bone resorption during that time, and minor complications occurred in only two of the patients. This procedure offered several advantages: 1) the bone graft, an autogenous material, can be used in previously infected areas; 2) the reconstruction contour is smooth and natural; 3) there was no morbidity or scarring at the donor site; 4) surgery time is much shorter than with split-rib cranioplasty. The primary disadvantage of split-skull cranioplasty is the decreased thickness of the skull at the donor site.