Role of systematic scalp expansion before cranioplasty in patients with craniectomy defects

Abstract Purpose Scalp management is challenging in all types of cranioplasties, particularly following decompression or in case of resorption of a repositioned bone flap. In these cases, reduction of brain volume is constantly associated with tightening of the skin cover. Material and methods A retrospective analysis of 36 cranioplasties was performed. All patients showed cranial decompression or a large craniectomy. In all cases, cranioplasty was preceded by a preliminary scalp expansion. Results Two patients had expander exposure. One of them underwent re-intervention, to reposition the implant. Complications of the cranioplasty phase were one case of extradural hematoma, five cases of swelling due to liquorrea, four cases of temporary forehead edema, and one case of temporal bulging due to the implant. Cranial decompression and other craniectomy procedures often produce a tightening of the scalp, which makes the cranioplasty problematic. The preliminary systematic scalp expansion performed in all patients resulted in a convenient skin excess that allowed a tension-less closure, preventing the scalp suture from falling right on the edge of the cranioplasty implant. Conclusion A systematic preliminary scalp expansion allows one to minimize cranioplasty complications in patients with craniectomies, to anticipate possible necrotic scalp complications in the expansion phase rather than in the cranioplasty phase, and thereby avoid implant loss.