Korean J Neurotrauma.  2018 Oct;14(2):105-111. 10.13004/kjnt.2018.14.2.105.

Initial Dead Space and Multiplicity of Bone Flap as Strong Risk Factors for Bone Flap Resorption after Cranioplasty for Traumatic Brain Injury

• Joo JK
• Choi JI
• Kim CH
• Lee HK
• Moon JG
• Cho TG

• KMID: 2424321
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.105

Abstract

OBJECTIVE
Bone flap resorption (BFR) is a complication of cranioplasty (CP) that increases the risk of brain damage and can cause cosmetic defects. In this study, the risk factors for BFR were examined to improve the prognosis of patients after CP for traumatic brain injury (TBI).
METHODS
This study was conducted in 80 patients with TBI who underwent decompressive craniectomy and CP with an autologous bone graft between August 2006 and August 2017. BFR was defined as a >0.1 ratio of the difference between the initial bone flap area and the last bone flap area to the craniectomy size and a < 0.5 ratio of the last bone flap thickness to the bone thickness of the contralateral region on computed tomography scans and plain skull radiographs. The patients were divided into the BFR and non-BFR groups, and medical data were compared between the two groups.
RESULTS
Among the 80 patients, 22 (27.5%) were diagnosed as having BFR after CP. The earliest cases of BFR occurred at 57 days after CP, and the latest BFR cases occurred at 3,677 days after CP. Using multivariate logistic regression analyses, the initial dead space size (odds ratio [OR], 1.002; 95% confidence interval [CI], 1.001-1.004; p=0.006) and multiplicity of the bone flap (OR, 3.058; 95% CI, 1.021-9.164; p=0.046) were found to be risk factors for BFR.
CONCLUSION
The risk factors for BFR in this study were the initial dead space size and multiplicity of the bone flap.

Keyword

Bone resorption; Brain injuries; Craniotomy; Transplantation

MeSH Terms

Bone Resorption
Brain
Brain Injuries*
Craniotomy
Decompressive Craniectomy
Humans
Logistic Models
Prognosis
Risk Factors*
Skull
Transplantation
Transplants

Figure

• 

  FIGURE 1 Flowchart for the inclusion of patients in this retrospective study. CP: cranioplasty, f/u: follow-up.

• 

  FIGURE 2 Plain skull radiographs in anteroposterior and lateral views. (A) Immediately after the operation; the yellow border indicates the initial bone flap area, the white border indicates the craniectomy area, and the red area indicates the initial dead space. (B) Two years after cranioplasty; the yellow border indicates the last bone flap area, which shows severe bone flap resorption. The areas were measured using free region of interest.

• 

  FIGURE 3 Computed tomography image of bone flap resorption at 2 years after cranioplasty, showing partial resorption of the bone flap, in which the remnant bone flap (thickness, 1.1 mm) was <50% as thick as the contralateral region (thickness, 6.1 mm) of the skull.

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