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Physician Update - Improving Round Two
Physician Update Fall 2014
Improving Round Two
Date: November 12, 2014
Neurosurgeon Judy Huang and craniofacial plastic surgeon Chad Gordon teamed up to offer cranioplasty patients a novel reconstruction technique that can reduce complications while offering a better aesthetic result.
Patients who need urgent surgery for ruptured aneurysms, brain traumas, brain tumors or other neurological injuries often have a portion of their skull removed that must later be replaced, necessitating a second operation.
That second procedure traditionally involves peeling back the scalp to expose the brain, which can cause significant blood loss, increase the risk of seizure and sometimes lead patients to regress in their neurological recovery. In addition, the placement of bone is often less than ideal, leaving an indentation in the temporal region that makes it obvious that a patient has undergone major brain surgery.
Though neurosurgeons have been performing cranioplasty reconstruction in much the same way for more than a century, it was clear that there was room for improvement, says Johns Hopkins neurosurgeon Judy Huang. So she and Johns Hopkins craniofacial plastic surgeon Chad Gordon, together with a group of neurosurgeons, teamed up to develop a novel repair technique that can prevent further brain trauma and risk for infection while also preserving the skull’s original appearance.
Rather than peeling back all five layers of the scalp, the new technique leaves the layer closest to the brain, the pericranium, attached, thereby preserving the brain’s protection and the pericranium’s blood flow. Working together, Huang and Gordon then place either the portion of original skull or a custom bonelike implant between the pericranium and overlying layers of scalp instead of directly onto the brain.
This innovative procedure spares the brain from additional insult while leaving healthy layers of tissue sandwiched around bone or implant, which in turn prevents the replaced material from getting infected and additional surgery to remove it.
“It not only creates a healthy environment around whatever material is used, but it also prevents a necessary dissection around the brain, thereby leading to safer surgery,” Gordon explains. In addition, he says, having the expertise of both a craniofacial plastic surgeon and neurosurgeon allows a more precise cranial reconstruction with better aesthetic results.
The ability to work together as part of a newly formed clinic, the Multidisciplinary Adult Cranioplasty Center, has allowed Huang and Gordon to combine their knowledge to improve patients’ experiences. They, along with several others, including neurosurgeons Henry Brem, Jon Weingart, Michael Lim, Alfredo Quinones-Hinojosa and Geoffrey Colby, now see cranioplasty patients together in clinic before surgery, giving patients an opportunity to have both doctors answer their questions and allowing surgeons to jointly plan for each complex procedure.