Korean J Neurotrauma.  2015 Apr;11(1):1-5. 10.13004/kjnt.2015.11.1.1.

Bone Flap Resorption Following Cranioplasty after Decompressive Craniectomy: Preliminary Report

• Kim JS
• Cheong JH
• Ryu JI
• Kim JM
• Kim CH

• KMID: 2156084
• DOI: http://doi.org/10.13004/kjnt.2015.11.1.1

Abstract

OBJECTIVE
Resorption of autologous bone flap grafts is a known long-term complication of cranioplasty following decompressive craniectomy (DC). We analyzed our data to identify risk factors for bone flap resorption (BFR) following cranioplasty.
METHODS
A total of 162 patients who underwent cranioplasty following DC due to life-threatening elevated intracranial pressure between October 2003 and December 2012, were included in our investigation. Follow-up exceeded one year.
RESULTS
BFR occurred as a long-term complication in 9 of the 162 patients (5.6%). The affected patients consisted of individuals who had undergone DC for traumatic brain injury (TBI; n=4), for subarachnoid hemorrhage (SAH; n=3), for cerebral infarction (n=1), and intracerebral hemorrhage (n=1). Logistic regression analysis identified no significant risk factors for BFR.
CONCLUSION
TBI and SAH as initial diagnoses are more often associated with BFR than other diagnoses. This finding may influence future surgical decision making, especially in patients with possible risk factors for BFR. A prospective study with a large number of patients is needed to identify potential predictors of BFR such as bone flap sterilization and preservation.

Keyword

Bone resorption; Cranioplasty; Decompressive craniectomy

MeSH Terms

Bone Resorption
Brain Injuries
Cerebral Hemorrhage
Cerebral Infarction
Decision Making
Decompressive Craniectomy*
Diagnosis
Follow-Up Studies
Humans
Intracranial Hypertension
Logistic Models
Risk Factors
Sterilization
Subarachnoid Hemorrhage
Transplants

Figure

• 

  FIGURE 1 A: Computed tomographic image of bone flap resorption demonstrating partial resorption of the bone flap, where the remnant bone flap was less than 50% as thick as the contralateral region of the skull. B: Photograph showing bone flap resorption. The multiple holes in the bone flap are thought to have been made for epidural tack-up suturing in the preceding cranioplasty. Such holes may expand as bone resorption progresses, causing cosmetic problems.

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