Early autologous bone flap cranioplasty following decompressive craniectomy in recovery treatment of children with severe TBI

Abstract

DC is one of the options in the staged therapy of refractory intracranial hypertension. A significant drawback of this technique is the formation of a complicated complex of pathophysiological disorders, which develops due to an extended defect in the calvarium (disorders of brain perfusion, venous outflow, CSF-circulation, etc.). Assess the effectiveness of early calvarium reconstruction with cryopreserved bone in children after decompressive craniotomy. Fifty-one patients had cranioplasty with cryopreserved bone after decompressive craniotomy during 2005–2016. The autobone was stored in the freezer at the temperature −40 °C. Before and after the surgery patients had CT-perfusion and MRI examination. In 70% of cases cranioplasty was made during the first two months. In 30% of followed cases the restoration of skull integrity took place up to 65 days. Late cranioplasty was caused by trophic disorders in soft tissues as well as by intracranial and extracranial infective–inflammatory complications. After the defect closure one could see restored brain perfusion, venous outflow. At the early postoperative period the auto transplant infectioning was seen in 5.5%. More than 75% of patients had clinical improvement, and 30% improved their outcome. The follow-up period lasted from 3 months until 10 years. Complete bone resorption was registered in one patient. Early closure defects of the calvarium should be regarded as a surgical intervention which provides maximally possible conditions for the early restoration of cerebral functions. Despite the higher risk of infection and resorption of the autobone remains the effective material for early cranioplasty in children.