Newswise — Plastic surgeons say they have developed a new surgical technique for complex skull reconstruction that could improve functional and aesthetic outcomes in cases that have previously been deemed impossible or unsafe and left patients with unsightly skull deformities requiring them to wear a helmet.
Reported online in The Journal of Neurosurgery, doctors, led by a Johns Hopkins’ craniofacial plastic surgeon, describe a case study, involving a single patient who benefited from the new technique to reshape the outer lining of his brain known as the dura. This allowed the surgeons to reconstruct his large skull defect using a combination of metal and acrylic commonly referred to as a cranioplasty.
This unprecedented surgery was performed at the Massachusetts General Hospital (MGH) and was led by Chad R. Gordon, D.O., now assistant professor in the Department of Plastic and Reconstructive Surgery at the Johns Hopkins University School of Medicine and former MGH associate staff member and craniomaxillofacial fellow at Harvard Medical School. The patient, a middle-aged male, had undergone surgery to remove a brain tumor by neurosurgery, which was subsequently complicated by a severe bone infection requiring partial removal of his skull bone. This left him with a significant skull deformity and helmet therapy was prescribed daily in an attempt to protect his exposed brain from further injury. During the prolonged time required to clear the bone infection, his brain had expanded outside the limits of his native skull, therefore making any type of standard skull reconstruction impossible.
“Up until now, the available options for skull reconstruction in these difficult scenarios have been less than ideal,” Gordon says. “Thousands of patients each year worldwide require neurosurgical procedures. Unfortunately, many are left with residual skull deformities because of unforeseen complications. This gives craniofacial surgeons a new weapon for reconstructing the human skull.”
Gordon and his colleagues decided to use a new approach they now refer to as a “bipolar duraplasty” to temporarily treat this patient's herniation. Using this maneuver, plastic surgeons employed low-level heat in a careful, precise manner to strategically shrink the brain instantaneously, thereby allowing them the opportunity to perform the planned cranioplasty. In this instance, metal and plastic are used in combination to replace the missing skull in its previous position. This provides permanent brain protection and, at the same time, restores an optimal aesthetic appearance. Bipolar cautery, as used here, is the first-ever reported case worldwide of craniofacial surgeons using bipolar electrocautery to temporarily reshape the brain.
“This new use was simply applying time-tested plastic surgery knowledge and experience to an otherwise difficult problem,” Gordon adds. “Without this innovation, this particular patient would have required either a partial brain resection, a complicated skull reshaping procedure, or perhaps he may have needed to wear a helmet for protection indefinitely.”
The patient was monitored closely for a year following his surgery and reported no complication. Gordon says he hopes to conduct a future clinical trial that will evaluate long-term outcomes in similar cranioplasty patients.
A video highlighting the Bipolar Duraplasty procedure can be viewed here: http://mfile.akamai.com/21490/wmv/digitalwbc.download.akamai.com/21492/wm.digitalsource-na-regional/jns11-744_video_source_video_1.asx (Media Player required). The patient in the video is the same patient who was the subject of the study published in the online version of The Journal of Neurosurgery.
Additional authors from MGH on this study include Edward W. Swanson, B.A.S., Tormod S. Westvik, M.D., and Michael J. Yaremchuk, M.D.
On the Web: PDF of the study in the online edition of The Journal of Neurosurgeryhttp://thejns.org/doi/pdf/10.3171/2011.7.JNS11744
The Department of Plastic and Reconstructive Surgery at Johns Hopkins http://www.hopkinsmedicine.org/plastic_reconstructive_surgery/
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