Autologous bone flap cranioplasty timing

see also Cranioplasty timing.

The risk of aseptic bone resorption lessens the longer the period of time elapsed between decompressive craniectomy (DC) and cranioplasty (CP). Age does not reveal a significant value, but statistical analysis shows that there is a clear trend 1).

Although generally accepted concept about the timing of cranioplasty using autologous bone is that early cranioplasty has more risk of infection and delayed cranioplasty has the risk of non-union or resorption of the bone flap.

There is an increasing body of evidence in the recent literature, which demonstrates that cranioplasty may also accelerate and improve neurological recovery. Although the exact pathophysiological mechanisms for this improvement remain essentially unknown, there is a rapidly growing number of neurosurgeons adopting this concept.

Cranioplasty performed between 15 and 30 days after initial craniectomy may minimize infection, seizure, and bone flap resorption, whereas waiting > 90 days may minimize hydrocephalus but may increase the risk of seizure 2).

Cranioplasty procedures should be performed at least 14 days after initial craniectomy to minimize infection risk. Obtaining intraoperative bone cultures at the time of craniectomy in the absence of clinical infection should be discontinued as the culture results were not a useful predictor of post cranioplasty infection and led to the unnecessary use of synthetic prostheses and increased health care costs 3).

Shin et al. observed new bone formation on all the frozen autologous bone flaps that were stored within 8 weeks. The timing of cranioplasty may show no difference in degree of new bone formation. Not only the healing period after cranioplasty but the time interval from craniectomy to cranioplasty could affect the new bone formation 4).

Rashidi A, Sandalcioglu IE, Luchtmann M. Aseptic bone-flap resorption after cranioplasty - incidence and risk factors. PLoS One. 2020 Jan 30;15(1):e0228009. doi: 10.1371/journal.pone.0228009. eCollection 2020. PubMed PMID: 31999739; PubMed Central PMCID: PMC6992164.
Morton RP, Abecassis IJ, Hanson JF, Barber JK, Chen M, Kelly CM, Nerva JD, Emerson SN, Ene CI, Levitt MR, Chowdhary MM, Ko AL, Chesnut RM. Timing of cranioplasty: a 10.75-year single-center analysis of 754 patients. J Neurosurg. 2018 Jun;128(6):1648-1652. doi: 10.3171/2016.11.JNS161917. Epub 2017 Aug 11. PubMed PMID: 28799868.
Morton RP, Abecassis IJ, Hanson JF, Barber J, Nerva JD, Emerson SN, Ene CI, Chowdhary MM, Levitt MR, Ko AL, Dellit TH, Chesnut RM. Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps. J Neurosurg. 2016 Sep;125(3):766-70. doi: 10.3171/2015.8.JNS151390. Epub 2016 Jan 15. PubMed PMID: 26771856.
Shin HS, Lee DW, Lee SH, Koh JS. Analyses Using Micro-CT Scans and Tissue Staining on New Bone Formation and Bone Fusion According to the Timing of Cranioplasty via Frozen Autologous Bone Flaps in Rabbits : A Preliminary Report. J Korean Neurosurg Soc. 2015 Apr;57(4):242-9. doi: 10.3340/jkns.2015.57.4.242. Epub 2015 Apr 24. PubMed PMID: 25932290; PubMed Central PMCID: PMC4414767.
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  • Last modified: 2020/03/07 10:18
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