{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:37:10Z","timestamp":1770115030402,"version":"3.49.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"15","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,4,14]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Cranioplasty is more than cosmetic repair for cranial defects; it is vital for patient rehabilitation after neurological injury. Despite its benefits, cranioplasty is associated with significant complications and requires careful planning. This report details the first reported case of subarachnoid hemorrhage (SAH) caused by failure and migration of titanium mesh used in suboccipital cranioplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 49-year-old male experienced recurrent SAH over 4 years, presenting every 2 years. Three years prior, the patient underwent suboccipital decompression craniotomy with titanium mesh implantation at another hospital. Imaging revealed mesh fracture with fragments migrating into the cervical spine at C3 and C4\u20135. The fractured edge of the mesh penetrated the dura and injured the cerebellar surface. A two-stage surgery removed the fractured mesh and migrated fragments successfully.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Suboccipital cranioplasty using titanium mesh and involving the posterior margin of the foramen magnum is at risk of mechanical failure. Stress on the implanted titanium mesh from cervical movement can lead to metal fatigue and injury to the brain, nerves, and blood vessels.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24836\">https:\/\/thejns.org\/doi\/10.3171\/CASE24836<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24836","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T20:16:18Z","timestamp":1744661778000},"source":"Crossref","is-referenced-by-count":0,"title":["Repetitive subarachnoid hemorrhage caused by fracture of titanium mesh used in cranioplasty in the posterior cranial fossa: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Yuki","family":"Ariyoshi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3178-4552","authenticated-orcid":true,"given":"Masahiro","family":"Sawada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Abekura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Hamamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Tanji","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6295-5510","authenticated-orcid":true,"given":"Takayuki","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4626-4645","authenticated-orcid":true,"given":"Yoshiki","family":"Arakawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases","volume":"26","author":"Gooch","year":"2009","unstructured":"Gooch MRGin GEKenning TJGerman JW.Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus. 2009;26(6):E9."},{"issue":"5","key":"bib2","series-title":"Acta Neurochir","first-page":"989","article-title":"Complications of titanium cranioplasty\u2014a retrospective analysis of 174 patients","volume":"156","author":"Mukherjee","year":"2014","unstructured":"Mukherjee SThakur BHaq IHettige SMartin AJ.Complications of titanium cranioplasty\u2014a retrospective analysis of 174 patients. Acta Neurochir. 2014;156(5):989-998."},{"issue":"4","key":"bib3","series-title":"Ann Plast Surg","first-page":"416","article-title":"Long-term outcomes of cranioplasty: titanium mesh is not a long-term solution in high-risk patients","volume":"81","author":"Kwiecien","year":"2018","unstructured":"Kwiecien GJRueda SCouto RALong-term outcomes of cranioplasty: titanium mesh is not a long-term solution in high-risk patients. Ann Plast Surg. 2018;81(4):416-422."},{"issue":"9","key":"bib4","series-title":"J Clin Neurosci","first-page":"1641","article-title":"Titanium mesh-assisted dural tenting for an expansile suboccipital cranioplasty in the treatment of Chiari I malformation","volume":"21","author":"Assina","year":"2014","unstructured":"Assina RMeleis AMCohen MAIqbal MOLiu JK.Titanium mesh-assisted dural tenting for an expansile suboccipital cranioplasty in the treatment of Chiari I malformation. J Clin Neurosci. 2014;21(9):1641-1646."},{"issue":"2","key":"bib5","series-title":"J Oral Maxillofac Surg","first-page":"182","article-title":"Fracture of mandibular reconstruction plates used after tumor resection","volume":"60","author":"Shibahara","year":"2002","unstructured":"Shibahara TNoma HFuruya YTakaki R.Fracture of mandibular reconstruction plates used after tumor resection. J Oral Maxillofac Surg. 2002;60(2):182-185."},{"issue":"1","key":"bib6","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"53","article-title":"Dacron mesh tray and cancellous bone in reconstruction of mandibular defects","volume":"112","author":"Albert","year":"1986","unstructured":"Albert TWSmith JDEverts ECCook TA.Dacron mesh tray and cancellous bone in reconstruction of mandibular defects. Arch Otolaryngol Head Neck Surg. 1986;112(1):53-59."},{"issue":"3","key":"bib7","series-title":"J Oral Maxillofac Surg","first-page":"348","article-title":"Material analysis of AO plate fracture cases","volume":"62","author":"Katakura","year":"2004","unstructured":"Katakura AShibahara TNoma HYoshinari M.Material analysis of AO plate fracture cases. J Oral Maxillofac Surg. 2004;62(3):348-352."},{"issue":"2","key":"bib8","series-title":"J Biomed Mater Res B Appl Biomater","first-page":"345","article-title":"Fracture of titanium plates used for mandibular reconstruction following ablative tumor surgery","volume":"80","author":"Martola","year":"2007","unstructured":"Martola MLindqvist CH\u00e4nninen HAl-Sukhun J.Fracture of titanium plates used for mandibular reconstruction following ablative tumor surgery. J Biomed Mater Res B Appl Biomater. 2007;80(2):345-352."},{"issue":"6","key":"bib1","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases","volume":"26","author":"Gooch","year":"2009","unstructured":"Gooch MRGin GEKenning TJGerman JW.Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus. 2009;26(6):E9."},{"issue":"5","key":"bib2","series-title":"Acta Neurochir","first-page":"989","article-title":"Complications of titanium cranioplasty\u2014a retrospective analysis of 174 patients","volume":"156","author":"Mukherjee","year":"2014","unstructured":"Mukherjee SThakur BHaq IHettige SMartin AJ.Complications of titanium cranioplasty\u2014a retrospective analysis of 174 patients. Acta Neurochir. 2014;156(5):989-998."},{"issue":"4","key":"bib3","series-title":"Ann Plast Surg","first-page":"416","article-title":"Long-term outcomes of cranioplasty: titanium mesh is not a long-term solution in high-risk patients","volume":"81","author":"Kwiecien","year":"2018","unstructured":"Kwiecien GJRueda SCouto RALong-term outcomes of cranioplasty: titanium mesh is not a long-term solution in high-risk patients. Ann Plast Surg. 2018;81(4):416-422."},{"issue":"9","key":"bib4","series-title":"J Clin Neurosci","first-page":"1641","article-title":"Titanium mesh-assisted dural tenting for an expansile suboccipital cranioplasty in the treatment of Chiari I malformation","volume":"21","author":"Assina","year":"2014","unstructured":"Assina RMeleis AMCohen MAIqbal MOLiu JK.Titanium mesh-assisted dural tenting for an expansile suboccipital cranioplasty in the treatment of Chiari I malformation. J Clin Neurosci. 2014;21(9):1641-1646."},{"issue":"2","key":"bib5","series-title":"J Oral Maxillofac Surg","first-page":"182","article-title":"Fracture of mandibular reconstruction plates used after tumor resection","volume":"60","author":"Shibahara","year":"2002","unstructured":"Shibahara TNoma HFuruya YTakaki R.Fracture of mandibular reconstruction plates used after tumor resection. J Oral Maxillofac Surg. 2002;60(2):182-185."},{"issue":"1","key":"bib6","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"53","article-title":"Dacron mesh tray and cancellous bone in reconstruction of mandibular defects","volume":"112","author":"Albert","year":"1986","unstructured":"Albert TWSmith JDEverts ECCook TA.Dacron mesh tray and cancellous bone in reconstruction of mandibular defects. Arch Otolaryngol Head Neck Surg. 1986;112(1):53-59."},{"issue":"3","key":"bib7","series-title":"J Oral Maxillofac Surg","first-page":"348","article-title":"Material analysis of AO plate fracture cases","volume":"62","author":"Katakura","year":"2004","unstructured":"Katakura AShibahara TNoma HYoshinari M.Material analysis of AO plate fracture cases. J Oral Maxillofac Surg. 2004;62(3):348-352."},{"issue":"2","key":"bib8","series-title":"J Biomed Mater Res B Appl Biomater","first-page":"345","article-title":"Fracture of titanium plates used for mandibular reconstruction following ablative tumor surgery","volume":"80","author":"Martola","year":"2007","unstructured":"Martola MLindqvist CH\u00e4nninen HAl-Sukhun J.Fracture of titanium plates used for mandibular reconstruction following ablative tumor surgery. J Biomed Mater Res B Appl Biomater. 2007;80(2):345-352."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/15\/article-CASE24836.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/15\/article-CASE24836.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/15\/article-CASE24836.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T23:40:19Z","timestamp":1770075619000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/15\/article-CASE24836.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":16,"journal-issue":{"issue":"15"},"URL":"https:\/\/doi.org\/10.3171\/case24836","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]}}}