J Korean Neurotraumatol Soc.  2009 Dec;5(2):118-123. 10.13004/jknts.2009.5.2.118.

Bone Resorption of Autologous Cranioplasty Following Decompressive Craniectomy in Children: Case Report

• Son S
• Park CW
• Kim EY
• Kim JM
• Yoo CJ

• KMID: 1427371
• DOI: http://doi.org/10.13004/jknts.2009.5.2.118

Abstract

OBJECTIVE
In pediatric patients, autologous-bone assisted cranioplasty is preferred because the child's original skull material will become reintegrated. Unfortunately, the replaced bone flap sometimes undergoes bone resorption, which results in structural breakdown necessitating reoperation. We report two children who underwent failure of autologous cranioplsty following decompressive craniectomy.
METHODS
An 11-year-old girl visited our emergency department with the chief complaint of stuporous mental change. Radiologic evaluations identified intracranial hemorrhage with arteriovenous malformation (AVM) in left fronto-parietal lobe. Decopmressive craniectomy and clipping of nidus of AVM was performed on the day on admission. After 1 month later, the autologous-bone assisted cranioplasty was performed. An 11-year-old boy visited our emergency department after trauma. The computed tomography (CT) scan revealed acute subdural hematoma in left cerebral convexity. Decompressive craniectomy was performed immediately. After 3 months later, the autologous-bone assisted cranioplasty was performed.
RESULTS
One year, and 2 months respectively after cranioplasty, they revisited outpatient service center with the chief complaint of breakdown of skull contour. The three dimensional CT scan revealed resorption of autologous bone graft. Repair was performed using porous polyethylene implant (Medpor(R), Porex Surgical, Inc, Newnan, GA, USA) and absorbable microplates.
CONCLUSION
The use of autologous bone flap for delayed cranioplasty following decompressive craniectomy should be reconsidered in light of the resorption in pediatric population.

Keyword

Autologous cranioplasty; Craniectomy; Children

MeSH Terms

Arteriovenous Malformations
Bone Resorption
Child
Decompressive Craniectomy
Emergencies
Hematoma, Subdural, Acute
Humans
Intracranial Hemorrhages
Light
Outpatients
Polyethylene
Reoperation
Skull
Stupor
Transplants
Polyethylene

Figure

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  FIGURE 1 Images of pre- and post-craniectomy. A: Enhanced brain computed tomography (CT) revealed intracranial hemorrhage with AVM nidus in left frontoparietal lobe. B-D: Skull X-rays and CT showed left craniectomy state. AVM: arteriovenous malformation.

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  FIGURE 2 Images of autologous cranioplasty. A: Skull X-rays. B: CT.

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  FIGURE 3 Resorption of autologous bone flap. A: Skull X-ray. B: Three dimensional CT.

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  FIGURE 4 Imagesof medpor cranioplasty. A: Skull X-ray. B: CT.

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  FIGURE 5 Images of pre- and post-craniectomy. A: CT revealed acute subdural hematoma and severe brain parenchymal edema in left cerebral convexity. B-D: Skull X-rays and CT showed left craniectomy state.

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  FIGURE 6 Images of autologous cranioplasty. A: Skull X-ray. B: CT.

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  FIGURE 7 Resorption of autologous bone flap. A: Skull X-ray. B: Three dimensional CT.

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  FIGURE 8 Images of revison operation. A: The resorpted autologous bone flap was fragile, dry and thin. B, C: Skull X-rays and CT showed Medpor® (Porex Surgical, Inc, Newnan, GA, USA) cranioplasty state.

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  FIGURE 9 Photomicrograph of resorpted bone flap (×400) showed extensive necrosis and chronic inflammation with fibrosis and foreign body reaction.

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