It really depends on the surgery.
Sometimes, a hole is drilled to do whatever surgery. This heals on its own, but a mesh may be used for larger holes.
Sometimes, the skull needs to be fixed, because a fracture is what was wrong with the patient. Depending on the size and type of fracture, metal plates, screws, mesh, or a combination of these, is needed to repair the fracture. Sometimes nothing at all is needed.
When undergoing brain surgery for certain issues, sometimes the surgeon can go through the nose to fix the problem. This is less invasive. Orher times, the surgeon may have to perform a skull flap surgery. Part of the skull is cut, set aside in antiseptic/saline, and the surgeon performs the surgery. After thr surgery is complete, the surgeon replaces the cut part of the skull, using tiny plates and screws to secure it, then letting it heal.
If a part of the skull itself is the issue (tumor originating from the bone, or part of the skull too damaged from, for example, a depression fracture, to repair), then mesh, donor graft, or plates and screws may be necessary.
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