Good news about my brother. Matt's reconstructive surgery has finally been deemed medically necessary.
A large portion of his skull was removed immediately after his accident to relieve pressure on his brain due to swelling. It was out for nearly 4 months while he was recovering from his coma. After it was reinserted, his body rejected his skull plate, and the bone has begun to die around the edges, so it's not fitting correctly, obviously.
The bone plate is putting pressure on his left brain, which is putting pressure on his right brain, which is causing him a lot of problems. If the pressure is high enough for a long enough time, he can start to have cell death around the edges. He also has excruciating migraines almost all of the time. I can't help but think that his cognitive recovery would be greatly assisted by relief from the headaches. How well would you be able to concentrate if you either had a huge headache all the time, or you were doped up for the pain?
So they're going to go in and remove the rejected bone, and replace it with a prosthetic, probably plastic and titanium, and then they're also going to do a muscle graft from his back or chest to rebuild the Temporalis muscle that atrophied during his coma, which should also give the prosthetic more support.
The surgery is going to be covered because the doctors have finally signed off that it's medically necessitated. However, the only facility in the region approved for this type of procedure is University of Cincinnati, which is great because they've been responsible for his care since his original airlift. The not-so-great part is that it's going to be considered "out of network" so there's going to be some out of pocket. Still, at least some of it is going to be covered.
As far as being concerned about the surgery and risks, etc... we're not all that worried. UC has taken great care of him all along, and he's already been through much worse than this. The other upshot is that even though he'll be in pain for a while after his surgery, he won't remember any of it within a few weeks. He doesn't even remember his daughter's birth, and that was just under a year ago, and it was also 2.5 years after his accident. There are pros and cons, I suppose.