Abstract
We report three cases of scalp rupture after cranioplasty using titanium plates. Case 1 is a 68-year-old man. Under the diagnosis of intracerebral hemorrhage, hematoma evacuation under endscope followed by a ventriculoperitoneal shunt was performed. Two years after the surgical intervention, his titanium plate became exposed from under the scalp. The titanium plate was removed and replaced with a bioabsorbable polymer. Case 2 is a 74-year-old female, who had surgery for a subarachnoid hemorrhage. Eleven years after the initial surgical intervention, removal of sequestrum and cranioplasty with titanium mesh was performed for her late-onset surgical site infection. After this surgical intervention, the mesh has become clearly visible through progressive skin thinning. Case 3 is a 65-year-old female, who underwent surgery for a subarachnoid hemorrhage. Six years after the surgery, the titanium plate which had been used for craniplasty at the initial surgery became exposed. Removal of the plate and scalp plasty to smooth the focally sharpened skull were performed. Scalp ruptures are usually caused by chronic stimulus caused by the titanium plate, incisional fragility of the scalp and subsidence of the scalp into the skull defect. Using a titanium plate on a curved or defected portion of the skull may also cause scalp rupture. We consider that bioabsorbable polymer may be useful to avoid these post-surgical cosmetic complications, especially in cases with these risk factors for scalp rupture.
