Blog 19 - Op #4 for Melissa - 3 1/2 years - Cranioplasty

Operation 4 for Melissa - November 2004 - Repair of Dura and Cranioplasty

We noticed soon after Melissa's bifrontal orbital advancement at 18 months that a lump started to grow beside her ear to ear scar. We brought this lump to the doctor's attention at Melissa's annual craniofacial clinic appointment in the following January. The plastic surgeon was not too worried about it but said he would keep an eye on it. We noticed that it was growing bigger so each time we took Nick in for an appointment with the plastic surgeon we would bring it to his attention. In about April he decided that it needed checking. He sent us to the neurosurgeon for his opinion. The neurosurgeon sent Melissa for a CT scan. It came back as showing that the dura was being pushed out through the weak skull bone. The skull bone had separated and there was no bone protecting the dura. This worried us but the neurosurgeon said that it needed to be fixed but that it was not urgent. He told us that this sometimes happens after craniofacial surgery.
The lump continued to grow and we started to become more concerned. After many enquiries to the hospital as to when this operation would be done we were told that it was scheduled for 4 weeks after Nick's frontal orbital advancement.

They did not want to put the operations too close together so we could rest inbetween (which did not happen in the end). As it turned out the operation was brought forward due to a cancellation. Nick was discharged and Melissa admitted on the same night. I did not leave the hospital for 3 weeks.

After Melissa had been wheeled into the OR I rang my boss to tell him that I would be extending my leave and explained the situation. He was very angry with me. He always told me that 'family comes first'...but I soon realised that if it inconvenienced him, then it didn't. After being berrated by him on the phone, and after what I had just been through with Nick, I dissolved into inconsolable tears.

Before the operation we brought to the neurosurgeon's attention that the lump had gotten bigger since the last CT scan so Melissa had another one done. From this it was thought that the top membrane of the dura had a tear and the bottom part of the dura was pushing up through it. It was obvious on the CT scan that there was no bone covering the area.

When the neurosurgeon went inside the situation was worse then what the CT scan showed. He found that there was a tear in the top dura (Dura Mater) and the bottom membranes (Arachnoid and Pia Mater) and the brain were pushing up through it. This meant that the neurosurgeon had to push the brain back down. He then had to repair the Dura Mater. To do this he took the lining of the muscle in Melissa's thigh and used that to strengthen the membrane. He said that it was weak due to scar tissue from the previous operations.

The second part of the operation was called a 'cranioplasty'. The word cranioplasty is a technical name for the reconstruction or reshaping of the skull. A cranioplasty can be performed using a number of techniques and materials, including bone grafts, metal plates, plastic, and mineral matrix materials.

In Melissa's case the cranioplasty involved the plastic surgeon filling in the gap where the skull was missing with a plate. He then put bone fragments on top of this plate. We have been told that Melissa's body will grow its own bone over the top of the plate so there would eventually be no hole. There is though still a dent.

The neurosurgeon was worried about complications from having to touch the brain. The area that could have been affected was the right hand side of Melissa's body. He was pretty certain that she would not have been able to walk again....but our God is gracious and was watching over her. Melissa is able to walk, jump, skip, swim. 

The operation took about 4 hours and she was in hospital for 6 days.

© 2012 by Jenny Woolsey

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