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Kim, Park, Kang, Kim, Cho, and Oh: Analysis of Cranioplasty Using Frozen Autologous Bone Following Post-Traumatic Decompressive Craniectomy
Clinical Article

Journal of Korean Neurotraumatology Society 2010; 6(1): 13-17.

Published online: 30 June 2010

DOI: https://doi.org/10.13004/jknts.2010.6.1.13

Analysis of Cranioplasty Using Frozen Autologous Bone Following Post-Traumatic Decompressive Craniectomy

Sang-Uk Kim, MD, Se-Hyuck Park, MD, Jeong-Han Kang, MD, Moon-Kyu Kim, MD, Byung-Moon Cho, MD, Sae-Moon Oh, MD

Department of Neurosurgery, Hallym University College of Medicine, Seoul, Korea.

Address for correspondence: Se-Hyuck Park, MD. Department of Neurosurgery, Hallym University College of Medicine, 150 Seongnae-gil, Gangdong-gu, Seoul 134-701, Korea. Tel: +82-2-2224-2236, Fax: +82-2-473-7387, sehyuck@hallym.or.kr

Received 2 April 2010       Revised 5 April 2010       Accepted 19 May 2010

Copyright © 2010 Journal of Korean Neurotraumatology Society

Abstract

Objective

We conducted this study to evaluate outcome of delayed cranioplasty using frozen autologous bone flap following decompressive craniectomy in patients with traumatic brain injury.

Methods

In 27 patients, 30 sites have undergone cranioplasty using frozen autologous bone flaps in the past 3 years. After decompressive craniectomy, bone flaps were stored at -40℃ for 3 to 316 days (mean, 55.6 days). Bone flaps were thawed at room temperature before cranioplasty and repositioned. Serial follow-up of skull x-ray and/or computed tomography was performed to monitor bony resorption and other complications. Follow-up periods ranged from 9 to 46 months (mean, 20 months).

Results

There was no surgically related complications. In 9 sites (30%), potoperative bone resorption was noted. Among them 3 sites underwent ventriculoperitoneal shunt (VPS) with multiple skull fractures and 2 sites underwent VPS without multiple skull fractures and 2 sites was with multiple bone fracture alone. In 7 sites with multiple skull fractures, resorption developed in 4 sites (57.1%) and 5 sites (83.3%) had resorption out of 6 sites with VPS. However, the aesthetic results were not dissatisfactory and a second cranioplasty was not indicated.

Conclusion

Cranioplasty using frozen autologous bone following post-traumatic decompressive craniectomy is associated with a high incidence of bone resorption, especially in patients with multiple skull fracture or VPS, even though the aesthetic results were not dissatisfactory. The most important factor for successful bone union was manipulation of bone flap in cranioplasty to facilitate bone resorption followed by accretion. Further improvements are required to perform cranioplasty in patients with VPS.

Keywords: Autologous bone, Bone resorption, Cranioplasty, Decompressive craniectomy, Traumatic brain injury

Figures and Tables

FIGURE 1
Case 24. A 68-year-old male patient presenting with acute subdural hemorrhage. A and B: Plain lateral skull film (A) and CT image (B) obtained immediate after cranioplasty. VPS catheter was seen. C and D: At 9 months after cranioplasty, plain lateral skull film (C) and CT image (D) showing bone resorption. Radiolucent lesion in the frontal and parietal area (C, arrowsheads) and thinning of the bone flap (D, arrows) were observed. VPS: ventriculoperitoneal shunt.
jknts-6-13-g001
TABLE 1
Demographic and operative details in 27 patients taken cranioplasty using frozen autologous bone
jknts-6-13-i001
TABLE 2
Summary of 8 patients showing postoperative bone resorption
jknts-6-13-i002

*bilateral cranioplasty. Cbr: cerebral, Depr. bone: depressed cranioplasty bone, F: female, Fx: fracture, HU: Hounsfield unit, M: male, Res. & Atro.: resorption & atrophy, Rt: right, SDH: subdural hematoma, VPS: ventriculoperitoneal shunt

TABLE 3
The results of postoperative bone resorption with the presence of multiple skull fractures and ventriculoperitoneal shunt
jknts-6-13-i003

VPS: ventriculoperitoneal shunt

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