Ariyoshi Yuki, Sawada Masahiro, Abekura Yu, Hamamoto Ryo, Tanji Masahiro, Kikuchi Takayuki, Arakawa Yoshiki
Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Neurosurg Case Lessons. 2025 Apr 14;9(15). doi: 10.3171/CASE24836.
Cranioplasty is more than cosmetic repair for cranial defects; it is vital for patient rehabilitation after neurological injury. Despite its benefits, cranioplasty is associated with significant complications and requires careful planning. This report details the first reported case of subarachnoid hemorrhage (SAH) caused by failure and migration of titanium mesh used in suboccipital cranioplasty.
A 49-year-old male experienced recurrent SAH over 4 years, presenting every 2 years. Three years prior, the patient underwent suboccipital decompression craniotomy with titanium mesh implantation at another hospital. Imaging revealed mesh fracture with fragments migrating into the cervical spine at C3 and C4-5. The fractured edge of the mesh penetrated the dura and injured the cerebellar surface. A two-stage surgery removed the fractured mesh and migrated fragments successfully.
Suboccipital cranioplasty using titanium mesh and involving the posterior margin of the foramen magnum is at risk of mechanical failure. Stress on the implanted titanium mesh from cervical movement can lead to metal fatigue and injury to the brain, nerves, and blood vessels. https://thejns.org/doi/10.3171/CASE24836.
颅骨成形术不仅仅是对颅骨缺损进行美容修复；对于神经损伤后的患者康复至关重要。尽管颅骨成形术有诸多益处，但它也伴有严重并发症，需要精心规划。本报告详细介绍了首例因枕下颅骨成形术中使用的钛网失败和移位导致蛛网膜下腔出血（SAH）的病例。
一名49岁男性在4年中反复发生SAH，每2年发作一次。3年前，该患者在另一家医院接受了枕下减压开颅术并植入钛网。影像学检查显示钛网骨折，碎片移位至颈椎C3和C4 - 5水平。钛网的骨折边缘穿透硬脑膜并损伤小脑表面。分两阶段手术成功取出了骨折的钛网和移位的碎片。
使用钛网且涉及枕骨大孔后缘的枕下颅骨成形术存在机械性失败的风险。颈部活动对植入钛网产生的应力可导致金属疲劳，并损伤脑、神经和血管。https://thejns.org/doi/10.3171/CASE24836 。
