814 Bifrontal Craniectomy and Reconstruction with Synthes - a Surgical Approach for the Management of Symptomatic Hyperostosis Frontalis Interna

Abstract

Abstract 57-year-old Caucasian female presented with depression, apathy, and personality changes with a markedly “flaccid face”. A computerized tomography (CT scan) revealed remarkable bilateral hyperostosis frontalis interna with significant frontal lobe compression. A definitive operative procedure with bilateral craniotomies was undertaken to relieve frontal compression and prevent further complications. During surgery, the bone flaps were found to be very hard to cut through with a craniotome or even a drill. The procedure was further complicated by dense adherence to the underlying dura. Craniotomy was eventually completed with multiple drilling efforts. Trimming down bone flaps proved to be difficult, thus they were not replaced back and were elected to be removed. Dura was covered with DuraGen and the galea was closed without the skull plates. Postsurgical imaging was done and synthetic bone plates made by “Synthes” were placed in a second-stage procedure. The patient recovered without significant focal deficits and remained stable at six months with an improved mental state. Pathology showed benign hyperostosis. This case highlights the difficulties of the surgical management of this rare case and discusses the improvised techniques adopted for the successful completion of the procedure with excellent outcomes.