Long-term follow-up for ossification of autologous bone plug and skin sinking after periosteum-preserved burr hole surgery

Abstract

Background:The demand of a burr hole surgery for chronic subdural hematoma (CSDH) is increasing in the global aging society. Burr hole-derived autologous bone dusts are not associated with extra costs compared with other commonly used synthetic materials. In addition, postoperative calvarium ossification requires periosteum-mediated blood supply, which is lacking after using avascular synthetic materials. Based on these findings, we hypothesized that the combination of the bone plugs and the preserved periosteum during burr hole surgeries for CSDH would induce efficient calvarium ossification.Methods:We evaluated the long-term effects of bone plugs on the degree of ossification and cosmetic appearance of the skin covering the burr hole sites. We included 8 patients (9 burr holes) who received the autologous bone dust derived from burr holes. As the control group, 9 burr holes that did not receive any burr hole plugs were retrospectively selected. These burr holes were evaluated by computed tomography (CT) scan for the calvarium defect ratios, CT value-based ossification, and the degree of skin sinking.Results:Ossification was observed in all the bone plugs by the bone density CT scans; they maintained their volume at 12 months after the surgeries. The calvarium defect ratios (volume ratios of the unossified parts in the burr holes) gradually increased during the first 6 months and reached 0.44 at 12 months. The mean CT values also increased from 527 HU to 750 HU for the first 6 months and reached 905 HU at 12 months. The degrees of skin sinking at the burr hole sites with the bone plugs were 1.24 mm whereas those without the bone plugs were 2.69 mm (P = 0.004).Conclusion:Application of burr hole-derived autologous bone dust is associated with better ossification and objective cosmetic result following burr hole surgery after CSDH.

Safety and Performance of a New Burr Hole Covering Device: Results of the Multicenter COVER Registry

“…Some have proposed the possibility of using buttons made of bone autografts, obtained from the inner table of the bone flap, to guarantee that there is no reaction to foreign materials and make the end of the surgery easier 2 . This is in line with another usual clinical practice: filling the burr holes with a pastry made of wet bone dustharvested from the patient at the beginning of the procedure-, to facilitate bone regeneration in the area 3,4 . This is an inexpensive method, easy to use and that can also offer a mostly positive cosmetic outcome.…”

“…Studies that have measured the depth of scalp depressions associated to burr holes in the long term, using CT scanning images, confirm this. The available results show that depression depth is 1.24 ± 0.78 mm in burr holes treated with bone dust plugs (at 12 months of follow-up) 3 , while it reaches only 0.16 ± 0.57 mm in burr holes covered with plates (at the latest follow-up image available; mean follow-up was 20.65 weeks) 10 . Recently, a study has also investigated the use of acellular dermal matrix as a burr hole cover.…”

“…This is an inexpensive method, easy to use and that can also offer a mostly positive cosmetic outcome. Furthermore, various adjuncts to the autologous bone dust have been described: e.g., it can be augmented with fibrin glue 5 or previously compressed into a solid plug 3,6,7 . However, this method has been related to post-operative complications, particularly for stand-alone burr-holes performed in endoscopic neurosurgery, caused by the migration of the material used to obstruct the burr hole into the endoscopy tract 8 .…”

Usefulness of Allogenic Acellular Dermal Matrix for Prevention of Scalp Depression after Burr Hole Trephination

“…Many materials such as autologous bone, muscle, fat tissue, and synthetic or metallic substitutes have been used to prevent skull defects. 2 5 12 22 23) In 2014, the clinical efficacy of a titanium burr hole cover was evaluated in our institute. 6) This material was effective cosmetically and functionally; however, several complications were expected, such as screw loosening, displacement of burr hole cover, implant protrusion, and scalp perforation.…”

Clinical Outcomes of 3D-Printed Bioresorbable Scaffolds for Bone Tissue Engineering—A Pilot Study on 126 Patients for Burrhole Covers in Subdural Hematoma

“…Various materials for burrhole covers have been proposed, including autologous bone grafts and dust [ 6 , 7 ], biomaterials such as porous polyethylene [ 8 ], poly(methyl methacrylate) (PMMA) [ 9 ], hydroxyapatite (HA) [ 10 , 11 ], mineralized collagen [ 12 ], and titanium [ 13 ]. These materials can potentially be toxic to cells [ 14 ], lack appropriate structures and interconnected porosity for vascular infiltration, or have limited biodegradability, introducing concerns for potential long-term complications.…”