Cranioplasty
Encyclopedia
Cranioplasty is a surgical
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 repair of a defect or deformity of a skull. Cranioplasty is almost as ancient as trepanation
Trepanation
Trepanning, also known as trephination, trephining or making a burr hole, is a surgical intervention in which a hole is drilled or scraped into the human skull, exposing the dura mater in order to treat health problems related to intracranial diseases. It may also refer to any "burr" hole created...

. There is evidence that Incan surgeons were performing cranioplasty using precious metals and gourds. Early surgical authors, such as Hippocrates
Hippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...

 and Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...

, do not discuss cranioplasty, and it was not until the 16th century that cranioplasty in the form of a gold plate was mentioned by Fallopius. The first bone graft was recorded by Job Janszoon van Meekeren
Job Janszoon van Meekeren
Job van Meekeren was a Dutch surgeon.Van Meekeren was a pupil of Nicolaas Tulp and became a surgeon in Amsterdam in 1635. He was respected by outstanding contemporary medical doctors for his knowledge of medical literature and his skills, who made a definite link between anatomy and surgery...

, who in 1668 noted that canine bone was used to repair a cranial defect in a Russian man. The next advance in cranioplasty was the experimental groundwork in bone grafting, performed in the late 19th century. The use of autografts for cranioplasty became popular in the early 20th century. The destructive nature of 20th century warfare provided an impetus to search for alternative metals and plastics to cover large cranial defects. The metallic bone substitutes have largely been replaced by modern plastics. Methyl methacrylate
Methyl methacrylate
Methyl methacrylate is an organic compound with the formula CH2=CCOOCH3. This colourless liquid, the methyl ester of methacrylic acid is a monomer produced on a large scale for the production of poly .-Production:...

was introduced in 1940 and is currently the most common material used. Research in cranioplasty is now directed at improving the ability of the host to regenerate bone. As modern day trephiners, neurosurgeons should be cognizant of how the technique of repairing a hole in the head has evolved. 3-D techniques are often used to work out plate sizes, and research into the subject is ongoing.
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