Failure of autologous bone—assisted cranioplasty following decompressive craniectomy in children and adolescents

Grant, Gerald A.; Jolley, Matthew A.; Ellenbogen, Richard G.; Roberts, Theodore S.; Gruss, Joseph; Loeser, John D.

doi:10.3171/ped.2004.100.2.0163

Cited by 213 publications

(267 citation statements)

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“…In this method, there is destruction of bone proteins so the bone flap does not revitalize, and chances of resorption and SSI after cranioplasty is more [20][21][22]. Studies [9] have documented that implanted bone flaps which are larger than 12 cm and have been preserved for more than 6-9 months (delayed cranioplasties), have a tendency for aseptic resorption resulting in deficiencies at the edges of the bone flap following reimplantation [23], which becomes evident clinically as well as radiographically. Studies have also documented that the longer the delay in cranioplasty, the greater are the chances of autogenous bone flap resorption as well as SSI following cranioplasty [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Although autografting, that is, either reimplantation of the excised bone flap [6,7], or transfer of cortical, cancellous or corticocancellous bone from any anatomic site to the defect site in the same subject, is obviously the best choice owing to the lack of immune or foreign body reactions, absence of a risk of transmission of disease, and the potential of the graft to be incorporated as biologically active and dynamic living tissue it has certain inherent limitations and disadvantages. Bone flap/graft resorption and infection [8,9], donor site morbidity, inadequate quantity of graft harvestable to bridge large cranial defects, prolonged intra-operative time, intraoperative blood loss and requirement of transfusions, need for surgical expertise and delayed post operative recovery [10] are definite drawbacks of autografting. Advanced age, presence of comorbidities, poor general condition of the patient, difficulties with bone flap storage, acute case scenarios and anatomical constraints can lead to difficulty in autografting or to the loss of the excised bone flap in a large number of cases [11,12].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature

Jeyaraj

2015

J. Maxillofac. Oral Surg.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature

Jeyaraj

2015

J. Maxillofac. Oral Surg.

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“…However, using autologous bone for cranioplasty has been suggested to result in a high incidence of bone resorption, particularly in the pediatric population: as high as 50% in that population, versus 0%-7% in the adult population. 8,20 Similarly, it has been reported to result in a high rate of surgical site infection: an average of 7.9% across 18 studies, according to a recent large-scale systematic review of postcranioplasty complications in adult patients. 20 This result suggests that surgical site infection is a significant cause of morbidity following cranioplasty in adults.…”

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confidence: 99%

“…Cranioplasty is subsequently required to restore cosmesis and to avoid physiological disturbances that may result from the cranial defect. 8,19 Repair of the skull defect using the original autologous bone has been advocated by some, since it maintains the proper contour of the skull, avoids introducing foreign material, 8 and can result in bone reintegration with the native calvaria during normal growth. However, using autologous bone for cranioplasty has been suggested to result in a high incidence of bone resorption, particularly in the pediatric population: as high as 50% in that population, versus 0%-7% in the adult population.…”

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confidence: 99%

Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

Rocque

Amancherla

Lew

et al. 2013

PED

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Cranioplasty is routinely performed following decompressive craniectomy in both adult and pediatric populations. In adults, this procedure is associated with higher rates of complications than is elective cranial surgery. This study is a review of the literature describing risk factors for complications after cranioplasty surgery in pediatric patients. A systematic search of PubMed, Cochrane, and SCOPUS databases was undertaken. Articles were selected based on their titles and abstracts. Only studies that focused on a pediatric population were included; case reports were excluded. Studies in which the authors assessed bone flap storage method, timing of cranioplasty, material used (synthetic vs autogenous), skull defect size, and/or complication rates (bone resorption and surgical site infection) were selected for further analysis. Eleven studies that included a total of 441 cranioplasties performed in the pediatric population are included in this review. The findings are as follows: 1) Based on analysis of pooled data, using cryopreserved bone flaps during cranioplasty may lead to a higher rate of bone resorption and lower rate of infection than using bone flaps stored at room temperature. 2) In 3 of 4 articles describing the effect of time between craniectomy and cranioplasty on complication rate, the authors found no significant effect, while in 1 the authors found that the incidence of bone resorption was significantly lower in children who had undergone early cranioplasty. Pooling of data was not possible for this analysis. 3) There are insufficient data to assess the effect of cranioplasty material on complication rate when considering only cranioplasties performed to repair decompressive craniectomy defects. However, when considering cranioplasties performed for any indication, those in which freshly harvested autograft is used may have a lower rate of resorption than those in which stored autograft is used. 4) There is no appreciable effect of craniectomy defect size or patient age on complication rate. There is a paucity of articles describing outcomes and complications following cranioplasty in children and adolescents. However, based on the studies examined in this systematic review, there are reasons to suspect that method of flap preservation, timing of surgery, and material used may be significant. Larger prospective and retrospective studies are needed to shed more light on this important issue.

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“…However, Grant et al reported a high rate (50%) of symptomatic bone resorption (requiring another surgery) in 40 cases of children and teenagers submitted to DC with bone stored in the bone bank 17 . Other techniques can be associated to an even higher resorption rate such as autoclaving the bone, once denaturation of proteins responsible for bone growth occurs 18 .…”

Section: Discussionmentioning

confidence: 99%

Decompressive craniotomy: prognostic factors and complications in 89 patients

Faleiro

Caetano

et al. 2008

Arq. Neuro-Psiquiatr.

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-Decompressive craniotomy (DC) is applied to treat post-traumatic intracranial hypertension (ICH).The purpose of this study is to identify prognostic factors and complications of unilateral DC. Eighty-nine patients submited to unilateral DC were retrospectively analyzed over a period of 30 months. Qui square independent test and Fisher test were used to identify prognostic factors. The majority of patients were male (87%). Traffic accidents had occurred in 47% of the cases. 64% of the patients had suffered severe head injury, while pupillary abnormalities were already present in 34%. Brain swelling plus acute subdural hematoma were the most common tomographic findings (64%). Complications occurred in 34.8% of the patients: subdural effusions in 10 (11.2%), hydrocephalus in 7 (7.9%) and infection in 14 (15.7%). The admittance Glasgow coma scale was a statistically significant predictor of outcome ( p=0.0309).KEY WORDS: head injury, intracranial hypertension, decompressive craniotomy. Craniotomia descompressiva: análise de fatores prognósticos e complicações em 89 pacientesResumo -A craniotomia descompressiva (CD) é técnica utilizada para tratamento da hipertensão intracraniana (HIC) pós-traumática. O objetivo do estudo foi determinar fatores prognósticos e complicações nos pacientes submetidos a esta técnica. Realizou-se estudo retrospectivo de 89 pacientes submetidos à CD unilateral para tratamento da HIC pós-traumática durante 30 meses. Utilizou-se testes do Qui-quadrado de independência e teste exato de Fisher para análise de fatores independentes de prognóstico. A maioria dos pacientes era do sexo masculino (87%). A causa mais comum foi o acidente de trânsito (47%). A maioria apresentava traumatismo cranioencefálico grave (64%), 34% já apresentavam anisocoria. O achado tomográfico mais comum foi a associação entre tumefação cerebral e hematoma subdural agudo (64%). Em 34,8% dos pacientes houve complicações inerentes à técnica: coleção subdural (11,2%), hidrocefalia (7,9%) e infecção (15,7%). A escala de coma de Glasgow à admissão correlacionou-se estatisticamente como fator prognóstico (p=0,0309). Decompressive craniotomy (DC) is a surgical method performed to immediately reduce intracranial pressure (ICP). It is usually indicated in cases of brain swelling (BS) and acute subdural hematoma (ASDH), or even for nontraumautic lesions in order to accommodate the swollen brain 1 . It consists of a unilateral craniotomy and dural augmentation. The bone can be temporarily stored in the abdominal subcutaneous tissue or can be disposed in case of a subsequent cranioplasty (with methylmethacrylate or titanium plate, among other materials). PALAVRAS-CHAVERecent studies have been evaluating DC efficacy when performed early in patients with severe traumatic brain injury (TBI) and with intracranial hypertension (ICH), yielding a superior result as compared to late performance or to specific clinical procedures (barbiturate coma and hypothermia) [2][3][4][5][6] . The purpose of this study was to evaluate prognostic...

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Failure of autologous bone—assisted cranioplasty following decompressive craniectomy in children and adolescents

Abstract: The use of autologous bone to reconstruct skull defects in pediatric patients after decompressive craniectomy is associated with a high incidence of bone resorption. The use of autologous bone should be reevaluated in light of the high rate of reoperation in this pediatric population.

Cited by 213 publications

References 0 publications

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature

Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

Decompressive craniotomy: prognostic factors and complications in 89 patients

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