Comparative study between cortical bone graft versus bone dust for reconstruction of cranial burr holes

Abstract

Background:As a consequence of the progressive evolution of neurosurgical techniques, there has been increasing concern with the esthetic aspects of burr holes. Therefore, the objective of this study was to compare the use of cortical bone graft and bone dust for correcting cranial deformities caused by neurosurgical trephines.Methods:Twenty-three patients were enrolled for cranial burr hole reconstruction with a 1-year follow-up. A total of 108 burr holes were treated; 36 burr holes were reconstructed with autogenous cortical bone discs (33.3%), and the remaining 72 with autogenous wet bone powder (66.6%). A trephine was specifically designed to produce this coin-shaped bone plug of 14 mm in diameter, which fit perfectly over the burr holes. The reconstructions were studied 12 months after the surgical procedure, using three-dimensional quantitative computed tomography. Additionally, general and plastic surgeons blinded for the study evaluated the cosmetic results of those areas, attributing scores from 0 to 10.Results:The mean bone densities were 987.95 ± 186.83 Hounsfield units (HU) for bone fragment and 473.55 ± 220.34 HU for bone dust (P < 0.001); the mean cosmetic scores were 9.5 for bone fragment and 5.7 for bone dust (P < 0.001).Conclusions:The use of autologous bone discs showed better results than bone dust for the reconstruction of cranial burr holes because of their lower degree of bone resorption and, consequently, better cosmetic results. The lack of donor site morbidity associated with procedural low cost qualifies the cortical autograft as the first choice for correcting cranial defects created by neurosurgical trephines.

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

“…Another study has compared autologous cortical bone grafts and bone dusts for burr hole reconstruction for craniotomy. [ 16 ] In this study, CT values of cortical bone grafts were almost equivalent to those of our bone plugs. Given the time and efforts of the cortical bone graft preparation, these findings suggest that the bone dust is the most useful autologous material for burr hole reconstruction while fibrin glue is unnecessary for this purpose.…”

“…[ 1 8 10 ] In this regard, the ossification effects of fibrin glue-solidified autologous bone dusts have been shown. [ 10 16 ] Nevertheless, the long-term effects of this strategy still remain unclear, particularly regarding the degrees of ossification and cosmetic outcomes of the skin above the burr hole sites. In addition, postoperative calvarium ossification is known to require preserved periosteum as the calvarium is remodeled only when the periosteal blood supply is maintained.…”

The Efficacy of Titanium Burr Hole Cover for Reconstruction of Skull Defect after Burr Hole Trephination of Chronic Subdural Hematoma

“… 6 , 14 , 15 , 17 , 23 , 24) These implants include organic substitutes such as autologous bone, muscle, or fat tissue, synthetic substitutes such as polymethyl methacrylate (PMMA), hydroxyapatite (HA), or polyethylene, and metallic substitutes. 23 , 28) Organic substitutes are highly biocompatible, but related with donor site complications, time consuming, and difficult to apply. PMMA can be easily applied, but it is time consuming and has thermal reaction which is toxic to surrounding tissues.…”

Biodegradable Mineralized Collagen Plug for the Reconstruction of Craniotomy Burr-Holes: A Report of Three Cases

“…There have been comparative studies of the two methods. Cortical bone discs have a lower resorption degree and showed better bone repair results and better cosmetic outcomes compared to those for the bone dust [37] . Similar to those orthopedic surgeries employing autologous bone, the amount of autologous bone is very limited for patients [38] , and the craniotomy flap becomes thinner after cortical bone discs are trephined.…”