He hit his head as he tumbled and was non-responsive when emergency personnel arrived. They rushed him to a nearby hospital, where a CT scan revealed that he had a major bleed in his brain. To save his life, surgeons stopped the bleed — and removed a large piece of his skull, which allowed room for his brain to swell without it getting squeezed to a potentially lethal degree.

Considering how unlucky he had been, the next few months proved to be extremely fortunate for Marr. He regained his speech and his pain eventually abated. Three months after the accident, he was back home in New York, spending time with Cobble and catching up with friends, although he remained on medical leave from his position as a technical consultant with Deloitte.

But Marr still faced one major issue: The  left side of his skull was missing — it looked as though his head was caved in.

A handprint-sized piece of skull was simply gone. The night of his accident, the surgeons had removed the bone to allow his brain to swell; they’d saved the piece of skull, but it would be months before it would be safe to think about reattaching it. The only barrier left to protect his brain was skin; a simple stumble could be life-threatening.

Whenever he left his apartment, he put on an impact-absorbing helmet. Marr’s close circle — his family, friends and girlfriend — let him know they found the helmet charming or entertaining. But strangers on the streets of New York were wary.   

“People look at you, you look at them, they look away. It can make you feel almost like a zoo animal,” says Marr. “You can feel the devils of low self-esteem. I started to get more and more interested in finding a way to recover from this completely.”

Cranioplasty surgery is a term referring to any procedure performed to correct deformities in the skull. Surgeons often recommend cranioplasty surgery both as a protective measure to plug weak spots in the cranial surface and as a cosmetic procedure to restore the skull's normal appearance.

Some brain surgery patients try, subsequent to their operation, to improve their appearance through cranioplasty surgery. However, that procedure has a high complication rate. That’s partly due to the fact that over the past century or so, neurosurgeons rightfully focused their research efforts on the brain; there wasn’t the same scientific exploration devoted to getting into and out of the brain and reconstructing the skull and scalp, says Dr. Ben-Shalom. As a result, patients are vulnerable to a host of long-term problems that range from deformities and scalp breakdown to infection, leaks of cerebrospinal fluid, hair loss, pain and more.

“Neuroplastic and reconstructive surgeons pulled from a variety of disciplines to address these issues,” he says. “We developed techniques and methods to optimize wound healing, prevent craniofacial deformities, avoid visible scars, mitigate risks for infections and ensure scalp durability. 

“It’s a holistic approach, and it’s personalized to the needs of the patient.”

Dr. Ben-Shalom’s team has also refined the implants used in cranioplasty surgery.

“Traditional cranial implants replace the bone, but not the muscle, fascia, fat and other tissue that is missing after you’ve removed part of the skull,” he explains. “In neuroplastics, we developed next-generation implants that not only restore the bone but the soft tissue, as well.”

One other benefit: The 3D-printed acrylic implants used by Dr. Ben-Shalom and his colleagues are sonolucent, meaning that sound waves easily pass through them. So after cranioplasty surgery Dr. Ben-Shalom can monitor the recovery of a post-op patient’s brain simply by holding a small ultrasound machine up to their head.

Neuroplastic surgery procedures, like cranioplasty surgery, appear to be vastly safer and more effective than older methods. During a fellowship at Johns Hopkins School of Medicine, where the surgical specialty was developed, Dr. Ben-Shalom reviewed data gathered on 500 cranioplasties that utilized newer neuroplastics techniques. His analysis showed that the complication rate was 15% — much lower than the 35% complication rate associated with the traditional approach. “That’s a game-changer,” he says.

Marr had no intention of living with a visibly deformed skull, but when he began researching reconstructive options, he was discouraged by the less-than-optimal outcomes and risks of traditional cranioplasty surgery. Then he heard about Dr. Ben-Shalom’s approach.

His first consultation with Dr. Ben-Shalom took place over Zoom, but it was thorough and wide-ranging. “He did an amazing job sharing his process,” says Marr, “and really made it feel like a team — like he was my teammate. And I knew the plan, and I knew the plan would succeed.

“He really wanted to hear about my wants and desires. I explained that I wanted to return to playing hockey, and he told me he would create the implant with that in mind.”

Marr’s girlfriend, by his side throughout the process, remembers a mix of emotions. “The first surgery was scary enough,” Cobble says. “To then have him go back under the knife … everyone obviously was nervous. But we had so much trust in Dr. Ben-Shalom and his team.”

In February 2022, Marr walked himself into the operating room at Lenox Hill Hospital. Dr. Ben-Shalom had spent countless hours in preparation — collaborating with the biomedical engineers as they custom-crafted Marr’s implant, vetting various renderings of the design before it was 3D-printed and carefully determining the precise surgical approach. But the cranioplasty surgery itself took less than three hours.