J Korean Neurotraumatol Soc.  2011 Apr;7(1):19-23. 10.13004/jknts.2011.7.1.19.

Availabilities of Cranioplasty with Autologous Bone Flap Preserved within Abdominal Subcutaneous Tissue after Decompressive Craniectomy

• Lim CH
• Min KS
• Lee MS
• Kim YG
• Kim DH

• KMID: 1427648
• DOI: http://doi.org/10.13004/jknts.2011.7.1.19

Abstract

OBJECTIVE
Autologous cranial bone flap can be preserved either by freezing or by placing in patient's own subcutaneous pocket. The aim of this study is to assess the effectiveness and safety of cranioplasty using an autologous bone flap preserved in a subcutaneous pocket in the patient's own abdominal wall.
METHODS
Twelve autologous bone flaps were preserved in patient's own abdominal subcutaneous pocket between January 2008 and January 2010 at Chungbuk National University Hospital. Two patients who died before cranioplasty due to severe postoperative brain swelling were excluded. We retrospectively reviewed the chart of 10 patients regarding following parameters; age, sex, Glascow Coma Scale score, Glascow Outcome Scale score, cause of craniectomy, interval between craniectomy and cranioplasty and complication.
RESULTS
The cause of craniectomy were severe traumatic brain injury in 9 patients and cerebral infarction in one patient. All of them received unilateral frontotemporoparietal craniectomy, 4 in left side and 6 in right side. The bone flap had been stored in the abdominal wall for an average period of 71 days. There was no postoperative infection or nonunion. All the cases were cosmetically satisfactory. Postoperative subdural fluid collection were developed in 3 cases and one of them underwent revision.
CONCLUSION
We found cranioplasty using autologous bone flap preserved in abdominal wall is safe and effective. Compared to heterologous bone flap and freezing method, autologous bone flap is inexpensive and simple option that preserves the viability of the bone flap. Also, it showed excellent cosmetic results.

Keyword

Decompressive craniectomy; Cranioplasty; Subcutaneous abdominal preservation

MeSH Terms

Abdominal Wall
Brain Edema
Brain Injuries
Cerebral Infarction
Coma
Cosmetics
Decompressive Craniectomy
Freezing
Humans
Retrospective Studies
Subcutaneous Tissue
Cosmetics

Figure

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  FIGURE 1 The photograph showing the location where the bone flap was banked. The transverse incision was made on the right upper quadrant of abdomen and the bone flap was placed between musculofascia and subcutaneous layer.

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  FIGURE 2 An illustrative case of a 57-year-old man who underwent craniectomy followed by cranioplasty after 50 months. A, B: Brain computed tomography and skull roentgenogram of anteroposterior views before cranioplasty. C, D: Brain computed tomography and skull roentgenogram of anteroposterior views after 10 months of cranioplasty.

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  FIGURE 3 Brain CT scans showing postoperative complication of subdural fluid collection after cranioplasty in 3 different patients. Subdural fluid collections were resolved spontaneously except one case (A) who underwent reoperation for its severity. (B, C) resolved spontaneously after conservative management.

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