Should My Elderly Father Undergo Skull Reconstruction After Head Injury?

Intracranial hemorrhage due to a car accident?

On April 22 at 10:00 AM, my father was involved in a car accident.
That afternoon, he experienced intracranial hemorrhage exceeding 30% of blood volume, necessitating an emergency surgery that evening to relieve intracranial pressure.
He has now been hospitalized for one month and two days and has returned home for recovery.
The doctor plans to perform surgery on August 23 to replace the left cranial bone.
However, for the past three months, he has not experienced headaches, but he has significant language impairment.
I would like to know if it is necessary to replace the left cranial bone.
Initially, the bone was preserved in a freezer.
Now, if it is to be replaced, my father is 86 years old.
He was relatively strong and could manage his daily activities independently, including caring for my sick mother, grocery shopping, cooking, and doing household chores.
However, considering the risks associated with surgery, will his condition post-surgery be better than if the cranial bone is not replaced?
Regarding the pain, weakness, and swelling in his right limbs, as well as his language function, can these improve with the replacement of the cranial bone and rehabilitation? He is quite resistant to rehabilitation, feeling like a useless person since he used to be fully capable.
This reluctance to engage in rehabilitation is a significant concern.
I want to confirm whether avoiding the surgery and minimizing the risk of external trauma to the unprotected brain is a better option, considering he does not go out except for hospital visits, which minimizes the chance of head impacts.
Should we avoid the risks of surgery and not replace the cranial bone, or is it essential to do so? What are the pros and cons of replacing versus not replacing the cranial bone?

Rongrong, 50~59 year old female. Ask Date: 2022/08/14

Dr. Zhao Shaoqing reply Neurosurgery

Hello; after a physician assesses that the brain condition is relatively stable, it is generally recommended to reattach and secure the skull defect.
Besides improving the aesthetic appearance after cranial reconstruction and protecting the extremely delicate brain tissue, it also helps to balance intracranial pressure and prevents the influence of atmospheric pressure on head trauma.
Post-surgery, patients often face not only rehabilitation and medication treatment but also significant psychological issues, which can create considerable stress for both caregivers and patients.
If you and your father have concerns about the safety and necessity of the cranial reconstruction surgery, it is advisable to consult with the original surgeon for professional advice and reassurance.
Thank you for your hard work! The Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2022/08/14

More Info

Deciding whether your elderly father should undergo skull reconstruction after a head injury is a complex issue that requires careful consideration of various medical factors, risks, and potential benefits. Given your father's history of significant head trauma, including intracranial bleeding and subsequent surgery, it is crucial to weigh the pros and cons of the proposed procedure.

Medical Considerations
1. Current Condition: Your father has been recovering at home for over three months without significant pain or discomfort, which is a positive sign. However, the loss of language function and other neurological deficits are concerning. These symptoms may or may not be directly related to the absence of the skull bone, but they warrant further evaluation.

2. Skull Reconstruction: The primary purpose of reconstructing the skull is to protect the brain from external trauma and to restore normal intracranial pressure. The absence of the skull can leave the brain vulnerable to injury, even with limited mobility. While your father may not be engaging in activities that pose a high risk of head injury, accidents can happen, especially in elderly patients.

3. Risks of Surgery: Any surgical procedure carries inherent risks, particularly in older adults. These risks include infection, complications from anesthesia, and the potential for further neurological deficits. Given your father's age (86 years) and his previous complications, these risks must be carefully considered.

4. Benefits of Reconstruction: Reconstructing the skull may improve your father's quality of life by providing better protection for the brain and potentially aiding in the recovery of lost functions, such as language and motor skills. However, the extent of recovery can vary significantly among individuals, and there is no guarantee that surgery will resolve his current issues.

5. Psychological Factors: Your father's mental state is also an important consideration. His feelings of hopelessness and reluctance to engage in rehabilitation can hinder recovery. Addressing these psychological aspects may be as crucial as the physical aspects of his care. Engaging a psychologist or counselor who specializes in geriatric care may help him cope with his situation better.

Alternatives to Surgery
If the decision is made to avoid surgery, it is essential to implement a robust rehabilitation plan. This plan should include:
- Physical Therapy: To address mobility issues and strengthen muscles.

- Speech Therapy: To help recover language skills and improve communication.

- Cognitive Therapy: To assist with memory and cognitive function.

Conclusion
In summary, the decision to proceed with skull reconstruction should be made collaboratively with your father's healthcare team, considering his overall health, the risks of surgery, and the potential benefits. It may be beneficial to seek a second opinion from a neurosurgeon who specializes in geriatric patients. They can provide insights into the necessity of the procedure based on your father's specific condition and history.

Ultimately, the choice should align with your father's values and preferences, ensuring that he feels supported and involved in the decision-making process. Whether or not to proceed with surgery, a comprehensive rehabilitation plan will be vital for his recovery and quality of life.

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