Last six months was a roller coaster ride for a four-year-old little girl and her family. As the fate played tricks in her life in the form of a fatal accident, severe head injuries and trauma were the ordeals for the little girl and her family. The four-year-old however miraculously survived, but the accident left her with a deformed cranial structure. Now, In a first, the doctors in the Pune Bharati Hospital have successfully replaced 60 per cent of the girl’s damaged skull. The doctors claimed 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 last year. Later she was discharged after two critical surgeries. But the doctors readmitted her to the hospital and she successfully underwent skull replacement surgery.
Dr Jitendra Oswal, who treated her initially said, “The impact of the accident was severe. She was brought to our hospital in an unconscious state.” “Since she was bleeding profusely from the head, she was immediately put on the ventilator support. Later, the CT scan showed severe brain swelling with a fracture to the rear bone of the skull. It was slightly compressing over the brain and had led to an excess accumulation of fluid (Edema) in the brain,” he added.
But since even after 48 hours, her clinical condition did not improve, the doctors repeated the CT scan. The reports showed Malignant Cerebral Edema, an uncommon and fatal complication of traumatic brain injury.
“The impact of the trauma was so severe that it had pushed entire brain off centre, which is known, medically, as a midline shift of the brain,” Dr Oswal added.
Since the brain edema didn’t subside even after artificial ventilation and medical therapy, doctors decided to operate her. Neurosurgeons removed the full frontal as well as partial parietal and temporal bones of the damaged skull, which provided the space to release the pressure on the brain.
“Usually, when the cranial bone is removed, it is refrigerated and re-implanted when the swelling subsides. But owing to her age and the brittle nature of her cranial bone, it had to be discarded. Post the surgery, Suhani responded well to the treatment and recovered gradually,” said Dr Vishal Rokade, her neurosurgeon.
The damaged skull was replaced with a customised three-dimensional polyethylene bone. It was made by a US-based firm as per the exact measurements and shape of the skull defect. Dr Rokade said: “We selected polyethylene material as it is biocompatible, porous and lightweight. The pores in the CCI implant are interconnected and omnidirectional, which help in the fibrovascular growth of the surrounding tissue. Also, the customisation aspect gave us the advantage to trim and perfectly fit the implant as per the exact defect in the patient’s skull.”
Though the surgery was a success, the significant cavity on the sides and back of the skull left her emotionally disturbed. Her mother said: “She used to be a chirpy child who loved playing in the outdoors and making friends. But the accident and a disfigured head had affected her confidence. She has become hesitant even to interact with her friends. She often touches her head as if wondering when this cavity would fill and she would also look like her friends and other kids. Watching her battle these thoughts was extremely painful for us. The very thought of what kind of challenges she would have to face in life due to a disfigured head, made us feel helpless.”

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4-year-old girl gets India’s first successful skull implant: Doctors

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