Sleeve cranioplasty: A novel endoscope-assisted cranioplasty technique after decompressive hemicraniectomy

Background: Cranioplasty (CP) for large cranial defects after decompressive hemicraniectomy carries high complication risks due to extensive scalp dissection. Here, we tested a novel, minimally invasive, endoscope-assisted technique combined with patient-specific 3D-printed cranial implants that we named Sleeve CP. Methods: We used endoscope-assisted epidural dissection through a minimal incision along the previous scar combined with the placement of a custom 3D-printed cranial implant. Data from two patients with large posthemicraniectomy cranial defects who underwent sleeve CP were used for illustration purposes. Results: Less than half of the scar was reopened. The operative time was under 1 h. Both patients had no postoperative complications, were discharged pain-free on postoperative day 2, and reported high satisfaction with the cosmetic results at the 1-month follow-up. Postoperative computed tomography scans confirmed optimal cranial implant positioning. Conclusion: We provide proof of principle for endoscope-assisted minimally invasive CP for large cranial defects using custom 3D-printed cranial implants. Based on our initial experience in two patients, this approach appears technically feasible and allows precise implant placement with limited scalp dissection and minimal intraoperative bleeding. Potential benefits may include reduced postoperative pain and surgical site infection; however, larger comparative studies are required to confirm safety, efficacy, and long-term outcomes.