The Use of Frozen Autogenous Bone Flaps in Delayed Cranioplasty Revisited

Iwama, Toru; Yamada, Jun; Imai, Syu; Shinoda, Jun; Funakoshi, Takashi; Sakai, Noboru

doi:10.1227/01.neu.0000047891.86938.46

Cited by 163 publications

(89 citation statements)

References 27 publications

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“…[10] The material provides perfect biocompatibility, shape and fusion with the surrounding bone. [12] For preservation of an explanted flap until the delayed reimplantation, the material is either implanted into a subcutaneous pouch [2,13] or cryoconserved.…”

Section: Introductionmentioning

confidence: 99%

What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients

et al. 2014

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BACKGROUND: Reimplantation of cryoconserved autologous bone flaps is a standard procedure after decompressive craniotomies. Aseptic necrosis and resorption are the most frequent complications of this procedure. At present there is no consensus regarding the definition of the relevant extent and indication for surgical revision. The objective of this retrospective analysis was to identify the incidence of bone flap resorption and the optimal duration of follow-up. METHODS: Between February 2009 and March 2012, 100 cryoconserved autologous bone flaps were reimplanted at the Department of Neurosurgery, Inselspital Bern. Three patients were not available for follow-up, and five patients died before follow-up. All patients underwent follow-up at 6 weeks and a second follow-up more than 12 months postoperatively. A clinical and CT-based score was developed for judgment of relevance and decision making for surgical revision. RESULTS: Mean follow-up period was 21.6 months postoperatively (range: 12 to 47 months); 48.9 % (45/92) of patients showed no signs of bone flap resorption, 20.7 % (19/92) showed minor resorption with no need for surgical revision, and 30.4 % (28/92) showed major resorption (in 4 % of these the bone flap was unstable or collapsed). CONCLUSIONS: Aseptic necrosis and resorption of reimplanted autologous bone flaps occurred more frequently in our series of patients than in most reports in the literature. Most cases were identified between 6 and 12 months postoperatively. Clinical observation or CT scans of patients with autologous bone flaps are recommended for at least 12 months. Patient-specific implants may be preferable to autologous bone flaps. This work has not been previously presented in part or in whole, and has not been concurrently submitted elsewhere.Disclosure of funding: The authors have declared no competing interests. The providers of the software had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No specific funding was provided for this work. 2 ABSTRACTBackground: Reimplantation of cryoconserved autologous bone flaps is a standard

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Section: Introductionmentioning

confidence: 99%

What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients

et al. 2014

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“…7 and 9). 31,38,66 Skull fractures identified at the time of the original decompression should raise concern for possible bone resorption following cranioplasty (Fig. 9).…”

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Complications of decompressive craniectomy for traumatic brain injury

Stiver¹

2009

FOC

382

302

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Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision-making during evaluation of potential surgical candidates. To further evaluate the complications of decompressive craniectomy, a review of the literature was performed following a detailed search of PubMed between 1980 and 2009. The author restricted her study to literature pertaining to decompressive craniectomy for patients with TBI. An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy. The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as subdural hygromas. Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.

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“…27,66 Once patients undergo decompressive craniectomy, those who survive are obligated to undergo a second procedure for surgical cranial reconstruction, that is, cranioplasty. Much of the modern literature regarding cranioplasty following decompressive craniectomy is based on case series that emphasize the technical aspects of the procedure such as the use of materials, 2,3,9,10,12,14,26,30,33,35,[50][51][52]54,55,60,63,68,70,71 the use of techniques to store the bone flap prior to reconstruction, 16,19,24,25,43,48,49,72 the timing of surgical intervention, 6,37 or other specific modifications to either the craniectomy or cranioplasty procedure, which may influence the cranioplasty. 20,28,34,36,38,41,47,67 There are relatively few modern-day large clinical series describing the clinical outcomes and perioperative complications of cranioplasties in the setting of nonpenetrating traumatic brain injury and large vessel infarction.…”

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confidence: 99%

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Gooch

Gin²,

Kenning³

et al. 2009

FOC

391

261

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Object Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients. Methods A retrospective chart review was undertaken of all patients who had undergone cranioplasty during a 7-year period. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. Patients were classified as having no complications, any complications, and complications requiring reoperation. The groups were compared to identify risk factors predictive of poor outcomes. Results The authors identified 62 patients who had undergone cranioplasty. The immediate postoperative complication rate was 34%. Of these, 46 patients did not require reoperation and 16 did. Of those requiring reoperation, 7 were due to infection, 2 from wound breakdown, 2 from intracranial hemorrhage, 3 from bone resorption, and 1 from a sunken cranioplasty, and 1 patient's cranioplasty procedure was prematurely ended due to intraoperative hypotension and bradycardia. The only factor statistically associated with need for reoperation was the presence of a bifrontal cranial defect (bifrontal: 8 [67%] of 12, requiring reoperation; unilateral: 8 [16%] of 49 requiring reoperation; p < 0.01) Conclusions Cranioplasty following decompressive craniectomy is associated with a high complication rate. Patients undergoing a bifrontal craniectomy are at significantly increased risk for postcranioplasty complications, including the need for reoperation.

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The Use of Frozen Autogenous Bone Flaps in Delayed Cranioplasty Revisited

Abstract: The clinical and aesthetic results of delayed cranioplasty using frozen autogenous bone flaps were satisfactory. The most important factor for success was excellent contiguity between the flap and the bone edge.

Cited by 163 publications

References 27 publications

What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients

What happens to the bone flap? Long-term outcome after reimplantation of cryoconserved bone flaps in a consecutive series of 92 patients

Complications of decompressive craniectomy for traumatic brain injury

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

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