Split calvarial bone graft for the reconstruction of skull defects

Abstract

Cranioplasty is a common, but formidable surgical procedure for neurosurgeons, in patients with scalp and / or calvarial defects. This procedure can be simple or complex. The main objectives of cranioplasty are: To achieve primary wound healing, obliterate dead space, and seal off sterile cranial areas from contaminated oronasal cavities, to restore the normal barriers protecting the intracranial structures (together with a satisfactory cosmetic result) and obtain a permanent or very durable reconstruction, using biologically inert materials, and also to restore the aesthetics. The greatest problem is selecting the optimum material for repair of the cranial defect. Many synthetic substitutions of the dura and bone are often used for reconstruction of the skull base; unfortunately, these methods bear significant disadvantages and can induce chronic inflammation, carry a high risk of infection, and are inferior to biological sources in terms of strength and sealing quality [with the exception of some materials, such as titanium mashes and CortossTM (Orthovita®, Malvern, USA), which are seen to have more strength than the thin split thickness calvarial bone]. The primary aim of this article is to review the basic principles to use the split calvarial graft for the reconstruction of the skull defect.

Concise Review: Mesenchymal Stem Cell Therapy for Pediatric Disease: Perspectives on Success and Potential Improvements

“…Calvarial (skull) bone reconstruction is needed in several pathogenic processes, including trauma, resection of tumors or infected bone, and congenital anomalies . The ideal replacement material is autologous bone because of its mechanical and immunological properties, but obtaining sufficient donor bone material in children is often difficult , . Therefore, Lendeckel et al described the use of ADSCs to repair traumatic skull defects in a 7‐year‐old girl.…”

Cranioplasty for Large-Sized Calvarial Defects in the Pediatric Population: A Review

“…27 This method has the advantage of using autologous bone in reconstruction, but adds morbidity of a donor site and results in two reconstructions both with reduced thickness and stability. 28 The bone flaps over the donor and recipient sites do not heal to full thickness. A well-developed diploic space is required so this method is less feasible in children younger than the age of 5 years.…”

A comparison between autograft alone, bone cement, and demineralized bone matrix in cranioplasty

“…Cranioplasty is a longstanding procedure that focuses on reconstruction of skull defects in order to provide an intact calvarium for protection of the brain from the oral and nasal cavities and external environment . Cranioplasty is also used to repair cosmetic deformities involving the calvarium . The defects repaired via cranioplasty range from contour irregularities to regions that are completely deficient of bone…”