In Situ Cranioplasty Technique for Immediate Calvarial Reconstruction to Optimize Cosmesis

Objective One of the goals of calvarial reconstruction after craniectomy is optimization of cosmesis. A simple technique for intraoperative generation of an implant based on the patient's native skull contour for immediate skull reconstruction after craniectomy is described. Methods In this technique, a titanium mesh is molded to the contour of the skull in situ and temporarily secured to the calvarium before the craniectomy. After the definitive portion of the procedure, the implant is resecured using the predrilled holes in the skull. Results In situ titanium cranioplasties are easily contoured to the patient's native skull before, and resecured after, craniectomy. Postoperative cosmesis is excellent. Conclusions In selected cases, this technique for in situ cranioplasty before craniectomy generates an implant that mimics the patient's calvarium and results in excellent cosmetic outcomes.