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Bony Union and Flap Resorption in Cranioplasty with Autologous Subcutaneous Pocket Preserved Bone Flap: Early Report on an Ambidirectional CT Scan-Based Study
Introduction Absence of sufficient number of prospective randomized controlled studies and comparatively small sample size and short follow-up period of most of the studies, available so far, have left ambiguity and lack of standardization of different aspects of cranioplasty.
Materials and Methods This is an early report of a computed tomography scan image-based ambidirectional study on cranioplasties performed with autologous subcutaneous pocket preserved bone flaps. Retrospective arm compared bony union and factors influencing it between cranioplasties and craniotomies. Patients with poor bony union and aseptic resorption were followed up in the prospective arm.
Results Retrospective arm of the study, followed up for five years (mean 32.2 months), comprised 42 patients as cases (Group 1) and 29 as controls (Group 2). Twenty-seven individuals (64.3%) in Group 1 had good bony union, as compared with 20 (68.9%) good unions in Group 2 out of the 29 patients. Four patients (9.5%) in Group 1 showed evidence of flap resorption, a finding absent in any patient in Group 2. Age, sex, smoking habits, superficial skin infection, and method of fixation did not appear to have any implication on bony union. Craniotomies done using Gigli saws fared better as compared with those done with pneumatic saw with lesser flap size–craniectomy size discrepancy, though it was not statistically significant. Fifteen patients have been included in the Prospective arm at the time of submission of this article.
Conclusion Ours is a study with a small sample size, unable to put its weight on any side, but can surely add some more data to help the Neurosurgeons in choosing the best for their patients.
26 March 2021 (online)
© 2021. Neurological Surgeons Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Vahedi K, Hofmeijer J, Juettler E. et al; DECIMAL, DESTINY, and HAMLET investigators. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007; 6 (03) 215-222
- 2 Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 2006; 104 (04) 469-479
- 3 Perin A, Nascimben E, Longatti P. Decompressive craniectomy in a case of intractable intracranial hypertension due to pneumococcal meningitis. Acta Neurochir (Wien) 2008; 150 (08) 837-842, discussion 842
- 4 Zuurbier SM, Coutinho JM, Majoie CBLM. Coert BA, van den Munckhof P, Stam J. Decompressive hemicraniectomy in severe cerebral venous thrombosis: a prospective case series. J Neurol 2012; 259 (06) 1099-1105
- 5 Schneider GH, Bardt T, Lanksch WR, Unterberg A. Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome. Acta Neurochir Suppl (Wien) 2002; 81: 77-79
- 6 Olivecrona M, Rodling-Wahlström M, Naredi S, Koskinen LO. Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma 2007; 24 (06) 927-935
- 7 Cooper DJ, Rosenfeld JV, Murray L. et al; DECRA Trial Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364 (16) 1493-1502
- 8 Carney N, Totten AM, O’Reilly C. et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery 2017; 80 (01) 6-15
- 9 Staffa G, Nataloni A, Compagnone C, Servadei F. Custom made cranioplasty prostheses in porous hydroxy-apatite using 3D design techniques: 7 years experience in 25 patients. Acta Neurochir (Wien) 2007; 149 (02) 161-170, discussion 170
- 10 Staffa G, Barbanera A, Faiola A. et al. Custom made bioceramic implants in complex and large cranial reconstruction: a two-year follow-up. J Craniomaxillofac Surg 2012; 40 (03) e65-e70
- 11 Kim B-J, Hong K-S, Park K-J, Park DH, Chung YG, Kang SH. Customized cranioplasty implants using three-dimensional printers and polymethyl-methacrylate casting. J Korean Neurosurg Soc 2012; 52 (06) 541-546
- 12 Lethaus B, Bloebaum M, Essers B. ter Laak MP, Steiner T, Kessler P. Patient-specific implants compared with stored bone grafts for patients with interval cranioplasty. J Craniofac Surg 2014; 25 (01) 206-209
- 13 Rosenthal G, Ng I, Moscovici S. et al. Polyetheretherketone implants for the repair of large cranial defects: a 3-center experience. Neurosurgery 2014; 75 (05) 523-529, discussion 528–529
- 14 Shah AM, Jung H, Skirboll S. Materials used in cranioplasty: a history and analysis. Neurosurg Focus 2014; 36 (04) E19
- 15 Flannery T, McConnell RS. Cranioplasty: why throw the bone flap out. ? Br J Neurosurg 2001; 15 (06) 518-520
- 16 Odom GL, Woodhall B, Wrenn FR Jr. The use of refrigerated autogenous bone flaps for cranioplasty. J Neurosurg 1952; 9 (06) 606-610
- 17 Zhang J, Peng F, Liu Z. et al. Cranioplasty with autogenous bone flaps cryopreserved in povidone iodine: a long-term follow-up study. J Neurosurg 2017; 127 (06) 1449-1456
- 18 Yadla S, Campbell PG, Chitale R, Maltenfort MG, Jabbour P, Sharan AD. Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery 2011; 68 (04) 1124-1129, discussion 1130
- 19 Rossini Z, Nicolosi F, Kolias AG, Hutchinson PJ, De Sanctis P, Servadei F. The history of decompressive craniectomy in traumatic brain injury. Front Neurol 2019; 10: 458 DOI: 10.3389/fneur.2019.00458.
- 20 Feroze AH, Walmsley GG, Choudhri O, Lorenz HP, Grant GA, Edwards MS. Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends. J Neurosurg 2015; 123 (04) 1098-1107
- 21 Andrabi SM, Sarmast AH, Kirmani AR, Bhat AR. Cranioplasty: indications, procedures, and outcome – an institutional experience. Surg Neurol Int 2017; 8: 91
- 22 Paredes I, Castaño-León AM, Munarriz PM. et al. Cranioplasty after decompressive craniectomy. A prospective series analyzing complications and clinical improvement. Neurocirugia (Astur) 2015; 26 (03) 115-125
- 23 Honeybul S, Morrison DA, Ho KM, Lind CRP, Geelhoed E. A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty. J Neurosurg 2017; 126 (01) 81-90
- 24 Kumar P, Kumar A, Jaiswal G, Gupta TK. Bone flap preservation in abdominal wall after decompressive craniectomy in head injury: a single institute experience. Romanian NeurosurgXXXII 2018; 3: 491-495
- 25 Krishnan P, Bhattacharyya AK, Sil K, De R. Bone flap preservation after decompressive craniectomy–experience with 55 cases. Neurol India 2006; 54 (03) 291-292
- 26 Morina A, Kelmendi F, Morina Q. et al. Cranioplasty with subcutaneously preserved autologous bone grafts in abdominal wall – experience with 75 cases in a post-war country Kosovo. Surg Neurol Int 2011; 2: 72 DOI: 10.4103/2152-7806.81735.
- 27 Shoakazemi A, Flannery T, McConnell RS. Long-term outcome of subcutaneously preserved autologous cranioplasty. Neurosurgery 2009; 65 (03) 505-510, discussion 510
- 28 Iwama T, Yamada J, Imai S, Shinoda J, Funakoshi T, Sakai N. The use of frozen autogenous bone flaps in delayed cranioplasty revisited. Neurosurgery 2003; 52 (03) 591-596, discussion 595–596
- 29 Fan MC, Wang QL, Sun P. et al. Cryopreservation of autologous cranial bone flaps for cranioplasty: a large sample retrospective study. World Neurosurg 2018; 109: e853-e859
- 30 Cheng CH, Lee HC, Chen CC, Cho DY, Lin HL. Cryopreservation versus subcutaneous preservation of autologous bone flaps for cranioplasty: comparison of the surgical site infection and bone resorption rates. Clin Neurol Neurosurg 2014; 124: 85-89
- 31 Ernst G, Qeadan F, Carlson AP. Subcutaneous bone flap storage after emergency craniectomy: cost-effectiveness and rate of resorption. J Neurosurg 2018; 129 (06) 1604-1610
- 32 Piitulainen JM, Kauko T, Aitasalo KM, Vuorinen V, Vallittu PK, Posti JP. Outcomes of cranioplasty with synthetic materials and autologous bone grafts. World Neurosurg 2015; 83 (05) 708-714
- 33 Adaaquah D, Gates M, Gompel JJ. Rate of craniotomy fusion after free bone flap. World Neurosurg 2018; 118: e283-e287
- 34 Vagnerova K, Koerner IP, Hurn PD. Gender and the injured brain. Anesth Analg 2008; 107 (01) 201-214
- 35 Jeon JP, Heo Y, Kang S-H, Yang JS, Choi HJ, Cho Y-J. Retrospective chronologic computed tomography analysis of bone flap fusion and resorption after craniotomy and autologous cryopreserved cranioplasty. World Neurosurg 2019; 129: e900-e906
- 36 Rish BL, Dillon JD, Meirowsky AM. et al. Cranioplasty: a review of 1030 cases of penetrating head injury. Neurosurgery 1979; 4 (05) 381-385
- 37 Bjornson A, Tajsic T, Kolias AG. et al. A case series of early and late cranioplasty - comparison of surgical outcomes. Acta Neurochir (Wien) 2019; 161 (03) 467-472
- 38 Aydin S, Kucukyuruk B, Abuzayed B, Aydin S, Sanus GZ. Cranioplasty: review of materials and techniques. J Neurosci Rural Pract 2011; 2 (02) 162-167
- 39 Carvi Y Nievas MN, Höllerhage HG. Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders. Neurol Res 2006; 28 (02) 139-144
- 40 Beauchamp KM, Kashuk J, Moore EE. et al. Cranioplasty after postinjury decompressive craniectomy: is timing of the essence?. J Trauma 2010; 69 (02) 270-274
- 41 Singh S, Singh R, Jain K, Walia B. Cranioplasty following decompressive craniectomy – analysis of complication rates and neurological outcomes: a single center study. Surg Neurol Int 2019; 10: 142 DOI: 10.25259/SNI_29_2019.
- 42 Lerch K-D. Reliability of cranial flap fixation techniques: comparative experimental evaluation of suturing, titanium miniplates, and a new rivet-like titanium clamp (CranioFix): technical note. Neurosurgery 1999; 44 (04) 902-905
- 43 Korhonen TK, Salokorpi N, Niinimäki J, Serlo W, Lehenkari P, Tetri S. Quantitative and qualitative analysis of bone flap resorption in patients undergoing cranioplasty after decompressive craniectomy. J Neurosurg 2018; 130 (01) 312-321
- 44 Ewald C, Duenisch P, Walter J. et al. Bone flap necrosis after decompressive hemicraniectomy for malignant middle cerebral artery infarction. Neurocrit Care 2014; 20 (01) 91-97
- 45 Dünisch P, Walter J, Sakr Y, Kalff R, Waschke A, Ewald C. Risk factors of aseptic bone resorption: a study after autologous bone flap reinsertion due to decompressive craniotomy. J Neurosurg 2013; 118 (05) 1141-1147
- 46 Ying K, Hsu S-K, Huang C-T. Bone flap malunion and resorption after cranioplasty with bioabsorbable implants in an adult drug abuser. Resuscitation & Intensive Care Med 2016; 1: 168-172
- 47 Yin J, Jiang Y. Completely resorption of autologous skull flap after orthotopic transplantation: a case report. Int J Clin Exp Med 2014; 7 (04) 1169-1171
- 48 de França SA, Nepomuceno TB, Paiva WS, Andrade AF, Teixeira MJ, Tavares WM. Cranial autologous bone flap resorption after a cranioplasty: a case report. Surg Neurol Int 2018; 9: 61
- 49 Son S, Park CW, Kim EY, Kim JM, Yoo CJ. Bone resorption of autologous cranioplasty following decompressive craniectomy in children. J Kor Neurotraumatol Soc 2009; 5: 118-12