Single-Stage Titanium Mesh Cranioplasty for the Treatment of Depressed Skull Fractures

BACKGROUND: Historically, depressed skull fractures that warranted surgery were treated in 2 stages: the first stage involved debridement and craniectomy, followed by the second stage of delayed cranioplasty. More recently, single-stage autologous cranioplasty has been proven to be safe. However, there is a paucity of literature regarding single-stage titanium mesh cranioplasty when autologous repair is not possible.METHODS: A retrospective review identified 22 patients who underwent single-stage titanium mesh cranioplasty for the acute treatment of comminuted depressed skull fractures. Fracture location, fracture etiology, timing of surgery, neurologic complications, infection, and cosmetic deformity were recorded. Average follow-up was 9 months.RESULTS: The mean age of the patients was 34 years (range: 3-77); 83% were male. Seventeen (77%) involved the frontal bone, with 7 (32%) involving the frontal sinus. Eighteen (82%) had open defects at presentation. Sixteen (73%) were neurologically normal. Average time from presentation to repair was 11 hours (range: 1-28 hours). There were no neurologic worsening, seizures, or in-fections postoperatively. Antibiotic prophylaxis was pre-scribed in 13 cases (57%). One patient required revision surgery for persistent cosmetic deformity.CONCLUSIONS: Autologous cranioplasty for depressed skull fractures is not always possible especially in cases of significant comminution. From our case series, single -stage titanium mesh cranioplasty appears to be a safe option.