Hi Doctor Joshua

please can you give me some advice, Im having a second cranioplasty operation in a few months to fill a defect which I was left with after a tumor removal in 1999 when I was 16. In May last year ( o6) I had a titanium plate fitted to the side of my skull but this has not made much difference to the defect around my left temporal part of my skull.
The surgeons have now told me that they can try once more using a cement, is this cement successful? I can send a pic and show you my defect and see what you think.

I am also considering paying for the operation and not having it on the NHS if i can be guranteed a good result.

I was wondering if you have done this type of surgery? Hopefully this time when the surgeons use the cement it will fill it in because I had a titanium plate fitted to the side of my skull in may 06 and i think the surgeons were hoping that the plate would push the muscle or fat back intowards the defect etc but this hasnt happened. I spoke to my hospital and they have told me its going to be around march time when they operate again.

If I could be guranteed by a surgeon that he/she can sort it out then Im willing to pay and even go abroad to have it done. With me already having 1 cranioplasty op in may 06 I dont think I can have too many more due to healing of the scar etc.

Doctor Joshua’s Answer

From your picture it looks like the defect may be caused by temporal muscle atrophy, a fairly common complication of craniotomy in that area. In such a case the problem is not really the bone or the cranioplasty - it’s the muscle, normally thick and providing shape to the temporal face area - after craniotomy it shrinks because the nerves inside the muscle are damaged, or the muscle itself is damaged.

I have done cranioplasties using frozen bone, titanium meshes, plates, cement, and combinations thereof, and I haven’t found much difference between these methods as far as the cosmetic result is concerned. However, in these cases the defect is usually caused by the bone defect itself, instead of the muscle. I’m not so much an expert on cosmetic corrective surgery.

In your case, a collaboration between a neurosurgeon and a plastic surgeon might yield the best results. Excess cement could indeed be used to provide the bulk that will restore the shape of the temporal area, so the face will look symmetrical. Maybe the plastic surgeon might have other ideas, too.

Talk to your doctor about these things - and keep us posted!

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