Cranioplasty recommended

Above: Bangladeshi Majibur Hakim (with bandaged head), after he had his skull reconstructed on Friday (Aug 3).

SINGAPORE - Two doctors who are not involved in Mr Majibar Hakim's case told The New Paper that patients can live without cranioplasty surgery, but they do so at the risk of sustaining a dangerous blow to the affected area.

Associate Professor Lim Thiam Chye from the National University Hospital (NUH) said the defect in the skull bone is not a condition that is lethal.

But Dr Lim, who heads NUH's division of plastic, reconstructive and aesthetic surgery, added: "It can be dangerous if (the patients) sustain a blow to the affected area. For this reason, I always recommend that the patient have the cranioplasty."

His colleague, Dr Sein Lwin, an associate consultant from NUH's division of neurosurgery, agreed.

He explained: "As there is no protective layer like skull bone between the brain and overlying skin, even minor trauma or direct pressure over the skull defect can damage the underlying brain and cause bleeding."

Dr Lim said that cranioplasty is done mainly to reconstruct the form of the skull to cover the defect and protect the brain, as well as for aesthetic appearance.

The procedure usually takes two to three hours, during which the skin is elevated from the brain membranes.

A titanium mesh is fashioned and shaped to the missing defect to reconstruct the skull. The skin is then replaced and closed to cover the titanium mesh, Dr Lim said.

Recovery time

Patients typically recover within 10 to 14 days.

Dr Lim qualified that such surgery is not recommended if the patient has a poor general condition that precludes general anaesthesia, or if the patient is confined to the bed and needs full-time care.

The two doctors explained that after a head injury, part of one's skull is sometimes removed to relieve pressure on the brain.

Dr Lim said that swelling of the brain often occurs after any injury.

"After the necessary neurosurgical procedure, it is not possible to replace the skull bone as the intracranial pressure inside the skull will go very high.

"If (the pressure is) unrelieved, it may cause death."

Dr Lwin agreed, saying said that the application of direct pressure to the brain surface can cause seizures, blackouts and neurological deficits like stroke.

The body's respiration centre and cardiac centre can get damaged, which can result in respiration and cardiac arrest.

Said Dr Lwin: "Removing the skull bone relieves this pressure by providing space for the brain to swell.

Such swelling usually subsides one week later, he added.


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