By Dragoslav Stula M.D. (auth.)

This monograph offers a finished evaluate of the scientific adventure in surgical fix of cranial defects which the writer has received in the course of a interval of over ten years. specific difficulties of sufferers present process cranioplasty, resembling neurological impairments, EEG alterations, adaptations of intracranial strain, and sinking epidermis flap syndrome are defined and mentioned. the writer provides convincing proof of the significance of cranioplasty in enhancing the standard of lifetime of sufferers with huge and disfiguring cranial defects. regrettably, cranioplasty nonetheless ameliorates basically to a minimum quantity the overall in sufferers soreness of significant cerebral lesions. i'm confident that this quantity will serve the aim it was once designed for : that it'll be a such a lot worthwhile creation into the issues regarding reconstructive surgical procedure. Basel, August 1984 Otmar Gratzl Contents advent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 A. heritage of Cranioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . three B. medical facets of Cranial Bone Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 I. foundation of Cranial Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1. bought Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2. Congenital Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . nine three. Demographic and different features of sufferers . . . . . . . . . . . . . . . . . nine II. Neurological and Psychic alterations ahead of and After Cranioplasty . . . . . . . eleven 1. class of Neurological Deficits and of the surface Flap varieties . . . . . thirteen 2. The "Sinking epidermis Flap Syndrome" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . sixteen three. The impact of Cranioplasty Upon Neurological and Psychic adjustments 17 III. Electroencephalographic (EEG) adjustments in sufferers with Cranial Defects 21 1. EEG Recordings and Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. assessment of EEG adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 IV. Scintigraphy Findings in sufferers with Cranial Bone Defects . . . . . . . . . . . . 26 1. Casuistic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2. effects and dialogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Example text

Moreover, the deleterious effects as well as the severity of the syndrome developing in large skull defects with pitted skin flap Fig. 30a. Hemisphere compression, brain mass displacement with ventricle deformation: usual picture of raised intracranial pressure in space occupying processes (here: chronic subdural haematoma) Fig. 30b. Cranial bone defect in a 19-year-old patient, 4 months after removal of an acute subdural haematoma. The same intracranial situation as in Fig. 30a but here without the intracranial space occupying process.

Prevention of Hemisphere Collapse The fact that cranioplasty could serve as a preventive measure or correction of hemisphere deformation and ventricle collapse, developing in large skull defects and frequently causing neurological impairments, has been recently indicated by some author", [162]. 35b Fig. 35 a. A 53-year-old patient showing hemisphere compression with brain mass displacement 2 months after removal of an acute subdural haematoma Fig. 35 b. Expansion of the brain and reversal of the brain mass displacement the very same day of the cranioplasty observed in patients in which large craniotomies because of acute traumatic hemorrhagies or tumourous infiltrations into the bone have been performed.

29. Schematic presentation of the effect of atmospheric pressure upon uncovered cranial defect (modification of the original presentation by Guido [68]) constituents is compensated by either the same or by enlargement of another element of the cranial contents [124]. Since the brain mass can be displaced to only a limited extent, an increase or decrease in the intracranial contents is achieved by changes in the volume of CSF and, in addition, by changes in the filled volume of the blood vessels [51].

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