Outcomes of Neuronavigation-Guided Cranioplasty: A Retrospective Study

BACKGROUND: Cranioplasty is a well-established neurosurgical procedure, but advancements in neuronavigation technology offer potential improvements in surgical outcomes.OBJECTIVE: The objective of this study was to evaluate the efficacy of neuronavigation-guided cranioplasty in enhancing cosmetic results and managing pre-existing neurological conditions. It evaluates the clinical and radiological outcome of neuronavigation-guided cranioplasty.METHODS: In this retrospective study, we analyzed the medical records of 16 patients admitted to the Adult Neurosurgery Department at King Fahad Medical City hospital in Saudi Arabia between November 2018 and June 2021. These patients were treated for swollen middle cerebral artery infarction or infection. Thirteen patients underwent decompressive craniectomy, and three had surgical evacuation of an epidural abscess. All patients received cranioplasty guided by pre- and intra-operative neuronavigation, utilizing polymethyl methacrylate, (PMMA), supported by titanium mesh, for reconstruction.RESULTS: The mean duration of the procedure was 97.81 ± 15.27 minutes. Fourteen (87.5%) patients displayed a well-contoured skull, while 2 (12.5%) patients experienced temporary soft swelling, which resolved during follow-up. In most cases, postoperative neurological symptoms were stable, while seizure frequency decreased in 3 patients. Complications included unintended durotomy in 2 (12.25%) patients (repaired without postoperative cerebrospinal fluid (CSF) leakage), temporalis muscle injury in 2 (12.5%) patients, and superficial wound infection in one (6.25%) patient. The study identified no adverse effects directly attributable to the neuronavigation technique.CONCLUSION: Neuronavigation-guided cranioplasty enhances the efficiency and outcomes of skull reconstruction procedures. By accurately defining bone edges and achieving precise cranial contours, it surpasses traditional free-hand techniques. PMMA implants, supported by titanium mesh, offer a reliable solution for replacing lost skull segments and serve as a practical alternative to autografts. This approach improves cosmetic results and contributes to greater patient satisfaction and operational efficiency.