J Korean Neurosurg Soc.  2017 Nov;60(6):749-754. 10.3340/jkns.2017.0203.002.

Bone Flap Resorption Following Cranioplasty with Autologous Bone: Quantitative Measurement of Bone Flap Resorption and Predictive Factors

• Park SP
• Kim JH
• Kang HI
• Kim DR
• Moon BG
• Kim JS

• KMID: 2395796
• DOI: http://doi.org/10.3340/jkns.2017.0203.002

Abstract

OBJECTIVE
To quantitatively measure the degree of bone flap resorption (BFR) following autologous bone cranioplasty and to investigate factors associated with BFR.
METHODS
We retrospectively reviewed 29 patients who underwent decompressive craniectomy and subsequent autologous bone cranioplasty between April 2005 and October 2014. BFR was defined as: 1) decrement ratio ([the ratio of initial BF size/craniectomy size]-[the ratio of last BF/craniectomy size]) >0.1; and 2) bone flap thinning or geometrical irregularity of bone flap shape on computed tomographic scan or skull plain X-ray. The minimal interval between craniectomy and cranioplasty was one month and the minimal follow-up period was one year. Clinical factors were compared between the BFR and no-BFR groups.
RESULTS
The time interval between craniectomy and cranioplasty was 175.7±258.2 days and the mean period of follow up was 1364±886.8 days. Among the 29 patients (mean age 48.1 years, male: female ratio 20: 9), BFR occurred in 8 patients (27.6%). In one patient, removal of the bone flap was carried out due to severe BFR. The overall rate of BFR was 0.10±0.11 over 3.7 years. Following univariate analysis, younger age (30.5±23.2 vs. 54.9±13.4) and longer follow-up period (2204.5±897.3 vs. 1044.1±655.1) were significantly associated with BFR (p=0.008 and 0.003, respectively).
CONCLUSION
The degree of BFR following autologous bone cranioplasty was 2.7%/year and was associated with younger age and longer follow-up period.

Keyword

Autografts; Bone resorption

MeSH Terms

Autografts
Bone Resorption
Decompressive Craniectomy
Female
Follow-Up Studies
Humans
Male
Retrospective Studies
Skull

Figure

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  Fig. 1 Flow chart showing inclusion and exclusion criteria. FCCD: fracture compound comminuted depressed, CP: cranioplasty, CE: craniectomy.

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  Fig. 2 Plain skull x-ray anteroposterior (A), lateral view (B), and computed tomographic scan (C) demonstrating severe bone flap resorption 8 years after cranioplasty.

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  Fig. 3 Quantitative measurement of two-dimensional bone flap size using a region of interest free draw curve.

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  Fig. 4 Box plot showing bone flap resorption related to the age at the date of CP (A) and bone flap resorption related to follow up period after CP (B). CP: cranioplasty.

Reference

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