Risk factors of aseptic bone resorption: a study after autologous bone flap reinsertion due to decompressive craniotomy

Dünisch, Pedro; Walter, Jan; Sakr, Yasser; Kalff, Rolf; Waschke, Albrecht; Ewald, Christian

doi:10.3171/2013.1.jns12860

Cited by 95 publications

(127 citation statements)

References 21 publications

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“…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]. Some data suggest that following DC, a good option would be to consider different alloplastic solutions for the repair, instead of the replacement of the patient's autogenous flap [26,27], and that the use of a Titanium mesh carries the lowest risk of infection [27], which makes sense because the patient's bone is a pabulum for bacteria (being devitalized but organic) [27], whereas Titanium is not.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…6,11,13,19,22 This is probably because there is a variation in both the definitions on what constitutes significant bone resorption and timing and methodology of follow-up for patients having autologous cranioplasty. In this study we used clinical assessments by both the patients and the treating study neurosurgeon, as well as radiological assessments at a standardized 12-month time point after cranioplasty, as previous studies have indicated that most resorption occurs within this time period.…”

Section: Bone Flap Resorptionmentioning

confidence: 99%

A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty

Honeybul

Morrison

et al. 2017

JNS

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OBJECTIVE Autologous bone is usually used to reconstruct skull defects following decompressive surgery. However, it is associated with a high failure rate due to infection and resorption. The aim of this study was to see whether it would be cost-effective to use titanium as a primary reconstructive material. METHODS Sixty-four patients were enrolled and randomized to receive either their own bone or a primary titanium cranioplasty. All surgical procedures were performed by the senior surgeon. Primary and secondary outcome measures were assessed at 1 year after cranioplasty. RESULTS There were no primary infections in either arm of the trial. There was one secondary infection of a titanium cranioplasty that had replaced a resorbed autologous cranioplasty. In the titanium group, no patient was considered to have partial or complete cranioplasty failure at 12 months of follow-up (p = 0.002) and none needed revision (p = 0.053). There were 2 deaths unrelated to the cranioplasty, one in each arm of the trial. Among the 31 patients who had an autologous cranioplasty, 7 patients (22%) had complete resorption of the autologous bone such that it was deemed a complete failure. Partial or complete autologous bone resorption appeared to be more common among young patients than older patients (32 vs 45 years old, p = 0.013). The total cumulative cost between the 2 groups was not significantly different (mean difference A$3281, 95% CI $−9869 to $3308; p = 0.327). CONCLUSIONS Primary titanium cranioplasty should be seriously considered for young patients who require reconstruction of the skull vault following decompressive craniectomy. Clinical trial registration no.: ACTRN12612000353897 (anzctr.org.au)

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“…[4] We found relevant resorption (according to the definition described above) in 30.4% of cases and performed reoperation and replacement with a patient-specific implant (PSI) in 27 cases (29.3%). Three patients with clear indication for bone flap replacement rejected the offer, despite the fact that in one case the dislocated bone flap was cosmetically unfavorable.…”

Section: The Bern Experience: High Incidence Of Bone Resorptionmentioning

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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Risk factors of aseptic bone resorption: a study after autologous bone flap reinsertion due to decompressive craniotomy

Cited by 95 publications

References 21 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

A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty

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

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