PUNE:
Doctors in Pune have successfully replaced 60% of a four-year-old girl’s damaged skull with a customised three-dimensional individualised polyethelene bone. The polyethelene bone was made by a US-based company as per the exact measurements and shape of
the skull defect. The doctors claimed that this was the first such
skull implant surgery successfully carried out in India.
The girl had sustained extreme skull damage in a four-wheeler accident near Shirwal on May 31 last year. She was then discharged from hospital after two critical surgeries. Doctors readmitted to hospital her this year and she successfully underwent the skull implant surgery on May 18.
The girl’s mother, a homemaker, said, “She is already attending school and enjoying playing with friends. She has become a happy and chirpy child like before.” The girl’s father is a school bus driver. The family lives in Kothrud.
Bharati Hospital’s paediatrician Jitendra Oswal, who treated the girl initially, said, “The impact of the accident was severe. She was brought to our hospital in an unconscious state and was bleeding profusely from the head. She was immediately put on ventilator support. The CT scan showed severe brain swelling with a fracture to the rear bone of the skull (occipital bone) that was slightly compressing over the brain. This had led to excess accumulation of fluid (edema) in the spaces of the brain.”
Oswal said that when the girl’s clinical condition did not improve even 48 hours after admission, a repeat CT scan was carried out which showed malignant cerebral edema, an uncommon and often fatal complication of traumatic brain injury. “The impact of the trauma was so severe that it had pushed the entire brain off centre, which is medically known as a midline shift of the brain,” he recalled.
With the brain edema not subsiding despite artificial ventilation and medical therapy, the girl was operated upon. Neurosurgeons removed the full frontal as well as partial parietal and temporal bones of the damaged skull, which provided space to release the pressure in the brain.
Neurosurgeon Vishal Rokade said, “Usually, when the cranial bone is removed, it is refrigerated and re-implanted after the swelling subsides. However, owing to the girl’s tender age and the brittle nature of her cranial bone, it had to be discarded. After the skull-bone removal surgery, the girl responded well to the treatment and recovered gradually. She was discharged after two months of hospitalisation.”
When the girl would come for subsequent check-ups, she would walk by herself, talk independently and need minimal assistance. However, the significant cavity on the sides and back of her skull left her emotionally disturbed. She would not mingle much with friends.
Around this time, a US-based medical device company announced the launch of their customised cranial implant (CCI) that could be used to reconstruct cranial cavities or deformities in such cases. With this technology, the implant could be customised as per the anatomical structure of the patient to fill the cranial bone cavity.
Since it was a first-of-its-kind in India, Rokade had initial apprehensions about conducting the procedure. However, after extensive research and consultation with surgeons from across the world, he decided to go ahead with it.
“We selected polyethylene material as its biocompatible, porous and light weight. The pores in the CCI implant are interconnected and omni-directional, which help in fibrovascular growth of the surrounding tissue. Also, the customization aspect allowed us to trim and perfectly fit the implant as per the exact defect in the patient’s skull,” Rokade said.
For a child barely four years old, there are very limited options to reconstruct the skull defect, Rokade said. “Besides, the skull bone grows and ideally any implant should allow this growth without hampering the shape of the skull. The skull bone grows till the age of 14 (puberty), so there could be chances of skull disfigurement,” he said.
“At her age, the growing skull requires an adjustable implant to allow normal skull expansion. Also, the implant should allow the surrounding tissue to grow inside allowing firm union. The CCI technology matches this requirement. This is not only the first skull implant surgery in India but in the entire Asia Pacific region,” Rokade said.