Cranioplasty can rapidly resolve neurological symptoms that come with missing a part of the skull. It also restores a person’s appearance and sense of self. Prior to cranioplasty, the skull may appear sunken or full in on one side, explains Netanel Ben-Shalom, MD, a neuroplastic and reconstructive surgeon at Lenox Hill Hospital.

“The deforming asymmetry can be striking — each time a patient looks in the mirror, it brings them back to the diagnosis, to the fear, to the trauma,” says the world-renowned expert, who leads Lenox Hill’s neuroplastic surgery program, the first of its kind in New York State. “My goal with cranioplasty is to reconstruct that so patients regain their confidence and sense of self next time they look in the mirror.”

If you or a loved one is considering cranioplasty, this guide will help you understand the procedure, the different materials used, and what to expect during surgery and recovery.

• Fatigue
• Headaches
• Trouble concentrating
• Memory loss
• Weakness or paralysis on one side of the body
• Inability to speak (aphasia) 
• Difficulty with coordination and balance
• Dizziness or vertigo
• Mood and personality changes

These symptoms can vary from mild to severe and happen because of changes to the pressure inside the head. “Normally, the skull provides a protective barrier that keeps everything balanced,” he says. ”When the brain is only covered by skin and soft tissue, outside pressure pushes in on the brain, altering your normal appearance and the fluid dynamics that keep everything working normally.” 

The added pressure can also disrupt blood flow, reducing the amount of oxygen certain areas of the brain receive. “The cortical blood vessels actually constrict because of this added pressure, resulting in reduced cerebral blood flow to critical regions,” Dr. Ben-Shalom says. This compressive effect also changes the flow of cerebrospinal fluid (CSF), which delivers nutrients and acts as a cushion for the brain. The result is impaired functions like balance, memory and even mobility. Cranioplasty helps restore normal brain function by rebuilding that protective barrier.

“We see patients who cannot move half of their body before cranioplasty,” Dr. Ben-Shalom notes. “After surgery, patients often regain lost function — and quickly. I remember a patient who could not talk for four months and was very sleepy. Just two days after the cranioplasty she started to speak.”

Cranioplasty surgery

To replace the missing bone, surgeons may use a patient’s own bone (known as an autologous transplant) or synthetic materials such as acrylics mesh or medical-grade titanium. When paired with advanced imaging and 3D modeling, surgical teams using synthetic materials can tailor the implant to the exact measurements of the patient’s skull defect. This approach, called virtual surgical planning, ensures that the implant integrates well with the patient’s tissue, reducing the likelihood of complications related to a bad fit or movement of the implant over time. 

Dr. Ben-Shalom says this has been a major advance that has helped to reduce complications and improve how patients look and feel. “We take everything into consideration: the location of the defect, the type of implant, the patient’s age, medical history and even their lifestyle and goals post-surgery,” he says.

Dedicated neuroplastic teams like the one at Lenox Hill Hospital are also making a significant difference. Unlike general neurosurgical teams, a neuroplastic team specializes in both the functional and cosmetic aspects of skull reconstruction. “While a neurosurgeon is focused solely on the engine of the car, the neuroplastic surgeon focuses on both the engine and the hood,” Dr. Ben-Shalom says.

In addition to training as a neurosurgeon, neuroplastic surgeons complete additional study in plastic and reconstructive surgery. This cross-section of skills remains unique, with just a handful of dedicated neuroplastic programs in the country. “And it allows us to focus on every detail: from scalp rearrangement to skull base reconstruction. We are laser-focused on preserving our patients' form and function, tailoring our approach to their unique needs,” Dr. Ben-Shalom explains.

Choosing what material to use for cranioplasty is complex, he explains, and requires weighing the strengths and weaknesses of each. 

Plastics

Titanium mesh cranioplasty

Titanium mesh is a lightweight, durable metal commonly used for cranioplasty. It is strong and less likely to corrode or degrade over time. This is crucial in surgical implants, which are intended to last for many years. It integrates well with the body’s tissues, reducing the risk of rejection or adverse reactions. Like any material, improper positioning and technique can cause discomfort or pain, as well as higher risk for complications.

While titanium is generally well-tolerated, sensitivity or allergic reactions may occur in rare cases.

Autologous cranioplasty

This procedure involves reattaching a patient's own bone, which was removed during surgery, to repair a defect in the skull. This approach significantly reduces the risk of rejection, as the body recognizes its own tissue, promoting better integration with surrounding structures. 

Using the patient’s own bone isn’t always an option if it becomes infected after removal. Even when preserved perfectly, Dr. Ben-Shalom explains, there is a high risk of infection and resorption (where the bone deteriorates over time), compared to synthetic materials. This can compromise the repair.

Another issue: Once a portion of bone is removed from the skull, it loses its blood supply.

Next-generation implants

Dr. Ben-Shalom’s team is now involved in developing what he calls next generation implants. “Not only are they replacing the hard coverage of the brain, but also the soft tissue.” These soft tissues include muscle, fat, connective tissue and even blood vessels.

“Now, our implants can compensate for soft tissue defects. These implants have the potential to house technologies, which will allow us to retrieve biometric data from the brain.”

These advancements in surgical techniques and implant materials are allowing more patients to undergo cranioplasty with fewer issues and a quicker return to normal life.

Cranioplasty recovery time

Most cranioplasty patients spend several days in the hospital for monitoring. Medical teams watch for any complications like bleedings and infections, which are high, compared with other types of brain surgery.

Cranioplasty complications

For a smooth recovery, Dr. Ben-Shalom recommends the following steps to reduce the risk of complications. 

• Choose your surgeon wisely: always consult a certified neuroplastic and reconstructive surgeon before cranioplasty.
• Follow post-surgical care instructions: Take prescribed medications and keep the surgical site clean and dry. 
• Take care of the surgical site: Avoid placing pressure on the area where the implant was inserted. When sleeping or resting, consider using specialized pillows or cushions. When resuming daily activities, doctors may recommend in some cases wearing a protective helmet to prevent trauma to the skull until the implant has fully integrated with the bone.
• Keep an eye out for signs of infection or fluid leaks: If the incision becomes red, swollen, or starts oozing fluid, or if you have persistent fevers, it could be a sign of infection. If you notice clear or straw-colored fluid leaking from the wound or nose, this could indicate a cerebrospinal fluid leak. Contact your doctor immediately if you notice any of these symptoms.
• Don’t miss any follow-up appointments: Your surgeon will check for signs of infection, implant movement, or other complications. Imaging like MRI or ultrasound may be used to monitor the implant’s position and overall brain health.
• Watch for neurological symptoms: Report any persistent or worsening headaches, confusion, or difficulty with coordination to your health care provider, as these could be signs of complications. While rare, seizures can sometimes occur after brain surgery. If you experience a seizure, seek medical help immediately.
• Take care when exercising: Avoid any activities that could put pressure on your head during the recovery period. Overexertion too soon after surgery can slow the healing process and increase the risk of complications.
• Continue to follow a healthy diet and lifestyle: A well-balanced diet rich in vitamins, minerals, and protein helps support wound healing and boosts your immune system. Drinking plenty of water will support tissue repair and overall recovery. Don’t smoke and avoid alcohol.