PMC4872371_01
The 3-D reconstruction CT imaging revealing a 6 x 8 cm skull defect at the right frontal-parietal-temporal skull prior to the cranioplasty.
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Head CT scans confirmed a 6 x 8 cm bone defect at the right frontal-parietal-temporal skull (Fig. 1).
(A) There existed a prominence at the right upper orbital region of the patient during the second visit (as indicated by the black arrow). (B-D) 3-D reconstruction CT imaging at sagittal, coronal and axial plane revealed titanium mesh prosthesis fracture, which was a 6 cm linear crack and extended from the proximal pterion point to the parietal bone. Clearly, the area in the black rectangular area in C was the skull basitemporal locus, which was absent of titanium screw in order to keep the integrity of the temporalis muscle during the first surgery.
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Thirteen months later, the patient re-visited our outpatient clinic and complained a prominence at the right upper orbital region appeared approximately 12 months post the first cranioplasty (Fig. 2A). Neurological examinations were unremarkable while the physical examinations identified a linear deformity, facing back and up at 45  and starting from proximal pterion point to an unclear ending point. 3-D reconstruction CT imaging revealed the clear edge of titanium mesh implant fracture, which was a 6 cm linear crack and extended from the proximal pterion point to the parietal bone (Fig. 2B-D).
(A and B) After the second cranioplasty, 3-D reconstruction CT imaging showed that the new titanium mesh prosthesis was intact and in an ideal position. During this cranioplasty, five screws were used to anchor the prosthesis onto the skull basitemporal locus (indicated as the rectangular area).
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The patient received a full recovery post-surgically and was discharged on the fourteenth day from admission before another 3-D reconstruction CT imaging (Fig. 3A and B).