Bone Resorption of Autologous Cranioplasty Following Decompressive Craniectomy in Children

Objective: In pediatric patients, autologous-bone assisted cranioplasty is preferred because the child’s original skull material will become reintegrated. Unfortunately, the replaced bone flap sometimes undergoes bone resorption, which results in structural breakdown necessitating reoperation. We report two children who underwent failure of autologous cranioplsty following decompressive craniectomy. Methods: An 11-year-old girl visited our emergency department with the chief complaint of stuporous mental change. Radiologic evaluations identified intracranial hemorrhage with arteriovenous malformation (AVM) in left fronto-parietal lobe. Decopmressive craniectomy and clipping of nidus of AVM was performed on the day on admission. After 1 month later, the autologous-bone assisted cranioplasty was performed. An 11year-old boy visited our emergency department after trauma. The computed tomography (CT) scan revealed acute subdural hematoma in left cerebral convexity. Decompressive craniectomy was performed immediately. After 3 months later, the autologous-bone assisted cranioplasty was performed. Results: One year, and 2 months respectively after cranioplasty, they revisited outpatient service center with the chief complaint of breakdown of skull contour. The three dimensional CT scan revealed resorption of autologous bone graft. Repair was performed using porous polyethylene implant (Medpor, Porex Surgical, Inc, Newnan, GA, USA) and absorbable microplates. Conclusion: The use of autologous bone flap for delayed cranioplasty following decompressive craniectomy should be reconsidered in light of the resorption in pediatric population. (J Kor Neurotraumatol Soc 2009;5:118-123)