Craniectomy complication

[Rlawson2765]

Help! The screws are backing out of my 10month old craniectomy done for a tumor.  2 in hole with 4 in plates.  What r my options for revision?  Maybe just mesh titanium.  Some on line posts show plastic? Help soon before this screw comes through my skin. I am in Tampa need a doc in Florida maybe Shands or USF

[caregiver222]

First off, you have a potential malpractice case, and the physician's involved are likely to be at general quarters. You can expect them to be disingenuous. The screws should NOT be loosening. That being said, medicine is an art, rather than a science and this does not mean that the physicians are incompetent or have been negligent. Nevertheless, you should contact an attorney and get an evaluation from a neurosurgeon surgeon that is not affiliated with the place that performed the surgery. You will need a copy of the operating room report and find out if the screws were cemented in and if so what cement was used and what brand and size of screw. The good news is that  timely intervention may resolve the issue without any long-term consequences. These screws go into the bone, and not into the brain.
The options are removal and recementing, and using blooded bone chips to fill in areas where new bone needs to grow. The FDA has looked at a varient of small-intestine pig mucosa to promote bone regrowth. You need to have this resolved at soon as possible. The surgery is simple, as long as there is no significant infection.

[S. Kaul, MD]

Hi there!

Well, without knowing the relevant clinical details or a detailed clinical evaluation it would be difficult to comment specifically on the situation. If the supporting screws are displaced, a review surgery may be suggested with possible replacement of supporting devices, though the review surgery may not be as complicated as the first surgery. It would be best to seek a review with your treating neurosurgeon for suggestion of an appropriate management plan.
Hope this is helpful.

Take care!