Masquelet induced cranial membrane under silicone layer during cranioplasty: Toward a natural technique for regeneration of meninges after decompressive craniectomy.

Reconstruction of the meninges and secondary hydrocephalus are salient issues following decompressive craniectomy. We propose a simple technique using a silicone sheet leaning on the opened dura mater and the brain during decompressive craniectomy. During cranioplasty, the removal of the silicone layer reveals that a new translucent and highly vascularized membrane has been naturally generated underneath, covering the dura mater flaps and the brain. We believe that this new cranial membrane arising from Masquelet's technique could allow covering large meningeal defects notably after wartime craniocerebral injury, and could also help reducing the occurrence of secondary hydrocephalus thanks to better cerebrospinal fluid circulation underneath.