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Abstract
Objective:
After decompressive craniectomy was performed in patients with severe brain swelling, we were able to preserve autologous bone flap as freeze-preserved state or within abdominal subcutaneous tissue. The aim of this study was to compare the freeze-preservation with the subcutaneous abdominal preservation regarding the effectiveness and safety.
Methods:
The clinical data of 53 patients who underwent decompressive craniectomy with autologous bone flap cranioplasty in our department were studied retrospectively. 43 patients underwent cranial reconstruction using autologous bone flap stored in deep freezer. In 10 patients cranioplasty was performed to repair bone defect using autologous bone flap preserved in subcutaneous abdomen. The analysis included the rates of infection, bone absorption and other complications and operation time to compare these two methods.
Results:
Cranioplasty using deep-freezing bone flap showed a low infection rate (2.3%), low bone absorption (2.3%) and no cosmetic problem. The average time of operation is 146 minutes. Cranioplasty using a bone flap banked in the patient's abdominal wall revealed no case of complications. The average time of operation is 130 minutes. The longer period the bone flap was preserved for, the longer time the operation took in both methods.
Conclusion:
This study may be worth considering that both methods of cryoconservation and subcutaneous abdominal pre-servetion are feasible for the repair of skull defect although abdominal preservation seems to show better result a little. If the deep-freezer is not available, a bone flap banked in the patient's abdominal wall can be used.
REFERENCES
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FIGURE 1.
Simple roentgenogram anteroposterior (A) and lateral (B) views 1 years after cranioplasty (B) using cryopreserved bone flap.
FIGURE 2.
Brain computed tomography (CT): Three-dimensional views before (A) and 60 days after cranioplasty (B) using cryopreserved bone flap.
FIGURE 3.
A case with postoperative infection. Epidural intracranial abscess after cranioplasty using cryopreserved bone flap. Brain CT was done 11 days after cranioplasty due to high fever and wound discharge. Non-contrast-enhanced CT (A) shows postoperative fluid collection at Right frontotemporal convexity. Contrast-enhanced CT (B) shows pachymeningeal thickening and enhancement at cranioplasty site. The patient was treated by antibiotic therapy for 6 weeks and recovered without reoperation.
TABLE 1.
Age and sex distribution
TABLE 2.
Etiology of brain swelling requiring decompressive craniectomy
| Etiology | Cryopreservation (43)∗ | Abdominal preservation (10) |
|---|---|---|
| Trauma | 27 | 4 |
| Infarction | 08 | 1 |
| SAH | 05 | 3 |
| ICH | 03 | 2 |
TABLE 3.
Mean operation time according to length of storage period
| Cryopreservation | Abdominal preservation | |||
|---|---|---|---|---|
| No. of cases | MOT | No. of cases | MOT | |
| ＜30 days | 03 | 115 | 0 | NA |
| 30-59 days | 23 | 140 | 4 | 114 |
| 60-89 days | 09 | 162 | 4 | 135 |
| ≥90 days | 08 | 159 | 2 | 153 |
TABLE 4.
Comparison of complications between subcutaneous abdominal preserved and cryopreserved autologous bone flap after decompressive craniectomy
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