During a craniotomy, a neurosurgeon temporarily removes a section of skull bone, known as the bone flap, to access the brain for a surgical procedure. Once that portion of the operation is complete, cranial fixation plates are used to reattach the bone flap securely to the surrounding skull. This step, called craniotomy closure, is a routine but critical part of neurosurgical practice, and the hardware involved is engineered specifically to hold bone in a stable position while natural healing occurs at the flap margins.
Why Is Bone Flap Fixation Necessary After a Craniotomy?
When the bone flap is removed, it is set aside and then returned to its original position at the end of the surgical procedure in most cases. However, bone on its own does not have any mechanism to hold itself in place against the surrounding skull immediately after replacement. Cranial fixation plates and their accompanying small screws span the gap between the flap and the adjacent bone edge, creating a rigid mechanical bridge that keeps the flap from shifting during the early healing period. Without this fixation, the flap would be vulnerable to displacement from normal head movement, changes in intracranial pressure, or minor external contact, any of which could interfere with proper bone healing.
How Do Titanium Plates Achieve Stable Fixation?
Titanium plates are the most common material used for cranial fixation because titanium is generally recognized for its favorable strength-to-weight ratio and long-standing use in implantable medical devices. A typical plate is a thin, low-profile piece of titanium shaped to sit across the junction between the bone flap and the surrounding skull, secured on each side with small self-tapping or pre-drilled screws. The low profile of these plates is intentional, since minimizing how much the hardware projects above the bone surface reduces palpability beneath the scalp and supports a smoother contour after the incision heals. Titanium's compatibility with medical imaging is also a relevant consideration, as patients who undergo cranial fixation may need CT or MRI follow-up imaging afterward.
What Happens During Craniotomy Closure?
Craniotomy closure begins once the intracranial portion of the surgery is finished and the surgical team is ready to replace the bone flap. The flap is repositioned against the surrounding bone edge, and fixation plates are placed at multiple points around its perimeter to distribute the mechanical load evenly rather than relying on a single fixation point. The number and placement of plates depends on the size of the flap and the specific anatomical location of the craniotomy. Once the bony fixation is complete, the surgical team proceeds with closing the overlying soft tissue layers in sequence to complete the procedure.
Stella Cranial Platinum Plate for Craniotomy Closure
INVAMED's Stella Cranial Platinum Plate is one example of a cranial fixation system designed for neurosurgical craniotomy closure. As described by the manufacturer, the Stella system uses platinum in its construction to provide biocompatibility and stability in skull reconstruction and in repair of cranial defects related to tumor removal. Systems like this are built specifically for the mechanical demands of bone flap fixation described above. Readers can explore the broader range of cranial and spinal fixation devices on the INVAMED neuro-spine-cranial products page.
Are cranial fixation plates removed after the bone heals?
In most cases, cranial fixation plates are designed to remain in place permanently once the bone flap has healed, since removal is not typically necessary unless a specific complication develops. A qualified physician determines whether removal is warranted for a given patient based on individual circumstances.
Can a patient feel the plates after craniotomy closure?
Because titanium and platinum cranial fixation plates are designed with a low profile, they are generally not prominently palpable beneath the scalp once soft tissue healing is complete, though some awareness of hardware near the incision site can vary by individual and by the specific location of the craniotomy. Any unusual swelling, pain, or drainage near the surgical site should prompt the patient to seek immediate medical care.
Is it safe to undergo an MRI with cranial fixation plates in place?
Titanium and platinum are generally considered compatible with MRI imaging, which is one reason these materials are commonly selected for cranial fixation hardware. However, imaging safety should always be confirmed by the radiology and surgical team based on the specific device used, and patients should inform their care providers about any implanted hardware before an MRI is scheduled.
Device availability and regulatory status vary by country. Please contact INVAMED or your authorized local distributor for current regulatory information applicable to your region.