PUNE: Doctors in the city have successfully replaced 60 per cent of a four-year-old girl’s damaged skull with a customised three-dimensional individualised polyethylene bone.The bone was made by a US-based firm as per the exact measurements and shape of the skull defect. The doctors claimed this was the first such skull implant surgery successfully carried out in India.The girl had sustained extreme skull damage in a four-wheeler accident near Shirwal on May 31 last year. She was discharged from hospital after two critical surgeries. Doctors readmitted her to hospital this year and she successfully underwent skull implant surgery on May 18.The girl’s mother, a homemaker, said, “She is already attending school and enjoying playing with friends. She has become a happy and chirpy child, like before.” Her father is a school bus driver. The family lives in Kothrud.Bharati Hospital’s Dr Jitendra Oswal, who treated her initially, said, “The impact of the accident was severe. She was brought to our hospital in an unconscious state.”The girl was bleeding profusely from the head. She was immediately put on ventilator support. The CT scan showed severe brain swelling with a fracture to the rear bone of the skull (occipital bone) that was slightly compressing over the brain. This had led to excess accumulation of fluid (edema) in the spaces of the brain,” Dr Oswal said.When her clinical condition did not improve even 48 hours after admission, a repeat CT scan was carried out which showed malignant cerebral edema, an uncommon and often fatal complication of traumatic brain injury. “The impact of the trauma was so severe that it had pushed the entire brain off centre, which is known, medically, as a midline shift of the brain,” Oswal said.With the brain edema not subsiding despite artificial ventilation and medical therapy, she was operated upon. Neurosurgeons removed the full frontal as well as partial parietal and temporal bones of the damaged skull, which provided space to release the pressure on the brain.Neurosurgeon Vishal Rokade said, “Usually, when the cranial bone is removed, it is refrigerated and re-implanted after the swelling subsides. However, owing to the girl’s tender age and the brittle nature of her cranial bone, it had to be discarded. After the skull-bone removal surgery, she responded well to treatment and recovered gradually. She was discharged after two months of hospitalisation.”The significant cavity on the sides and back of her skull left her emotionally disturbed. She would not mingle much with friends.