Phil’s Complex Cranioplasty

17 May 2023

As part of Action for brain injury week we spoke to Rachel and Phil Akehurst who have shared their story to educate others and raise awareness of how life can change in an instant.

"Phil and I are happy to share our story as part of Brain Injury Awareness week to help educate others and raise awareness of how life can change in an instant.  The chapter we share today is about his craniotomy procedure and just one chapter of a very long book.

On 23rd December 2020, Phil was crossing the road and was hit head on by a pizza delivery driver.

He was taken by ambulance to our local A&E (Whiston) who refused him access as his injuries were too severe. He was taken to Aintree A&E where the team spent 3 hours stabilizing him before I was able to see him. When the doctor came to speak to me, all I heard was “massive brain hemorrhage” “multiple areas of damage to the brain” and “unlikely to survive” before I ran off to be sick and my legs gave way.

When I finally got to see Phil that night, he looked absolutely perfect: No scratches, no cuts, and no grazes. It was very surreal. I spent ten minutes with him, stroking his skin and talking to him, begging him to wake up, before I was told I needed to leave (Covid restrictions at that time were in place). Phil was then transferred to Walton Neurological Centre.

I arrived home at 3am. It was now Christmas Eve. Our 4 year old son Sam was fast asleep in bed completely unaware. My parents had stayed with him whilst I was at the hospital. Sam woke at 4am for a cuddle, and I somehow managed to get him back to sleep without him knowing what was going on elsewhere. I remember thinking to myself at this point “I can to do this. I have to. For Sam”. He woke properly for the day at 7am and I told him about the accident. I will NEVER forget those big blue sleepy eyes looking at me in disbelief as his little mind tried to make sense of my words.

Phil continued to deteriorate over the next few days.

Four days after the accident, Phil had a bi-frontal decompressive craniotomy. His brain pressure was becoming so high because his brain had swollen so much that his skull was causing more damage to his brain.  He had to have his entire frontal skull removed. I was told that this was a “last resort”.  This surgery turned out to be the best course of action for Phil because after the operation his brain had room to swell and he started to stabilize. He remained in a coma for 2.5 weeks before he very slowly began to emerge.

Here's Phil about a month after the craniotomy during a video call with me and Sam (no visiting was allowed on the wards, again because of Covid). At this stage, Phil was very agitated and confused. The pressure in his brain had gone back to normal and so his head was now “scooped” in with there being no frontal skull in place.

Phil needed to wear a safety helmet as his brain was very vulnerable now.

Fast forward 18 months, and we began the very long and complex process of Phil’s cranio reconstruction. Because it was a large area of skull that was missing, and because his skin had shrunk, Phil needed a “complex cranioplasty” involving both plastic surgeons and neurosurgeons. It took 5 months to complete and involved two major surgeries and 17 weekly procedures.

For the first step, Phil had a balloon expander put into his scalp during March 2022.

The balloon under his scalp was filled every week with fluid in order to stretch and grow the skin. After 16 weeks, he had almost 400mls of fluid in the balloon and an 8cm “growth” on top of his head. Here’s some photos of what happened during that time.

Week 17

Phil’s rehab was mostly put on hold during all of this. He wasn’t able to wear his safety helmet as the skin was being stretched and he had more seizures than usual. Because of this, I needed to be with him 24/7. It was an incredibly tough time for us as a family, and A LOT of staring from strangers when we were out and about. We (literally) held our heads high and we carried on as best we could. It would have been so easy for Phil to hideaway at home during all of this, and I’m so proud of him for how he handled the very stressful situation with pride and determination.

In July this year, Phil had a ceramic skull put in. The surgery took 7 hours to complete, involved three fantastic surgeons, and because it was a fairly revolutionary reconstruction, he was interviewed by a camera crew and the whole thing was filmed to train other surgeons. Here’s some photos of Phil recovering.

About two months after the surgery, I noticed quite a leap in Phil’s recovery on the whole. And this has kept on coming and coming. He is more chatty, more confident, his information processing and memory have all started to improve too.

Although very very stressful, and an extra layer of trauma and worry on top of recovering from a very serious accident, Phil’s surgery has made a very positive difference to his life and our life as a family.

One thing that helped was to take each stage of the surgery one step at a time, and not to look too far ahead. I love the saying “keep your head where your feet are” to help us stay focused on the present. And we apply this to Phil’s recovery as a whole now – setting goals and breaking them down into small (sometimes tiny) and realistic steps, and cracking on with determination.

We love you Phil so much and are so proud of how far you have come xxx"


By Rachel and Phil Akehurst