In Situ Reconstruction of Parietal Bone Craniectomy After Convexity Meningioma Resection

Abstract

H yperostosis of the cranial vault or base is commonly related to meningioma with or without invasion of the skull bones. Calvarial hyperostosis with meningioma invasion is commonly associated with an increased rate of recurrence if limited bone resection is performed (4). On the other hand, poor cosmetic outcome is evident if aggressive bone resection is preferred. Cranioplasty has the theoretical potential of negating the cosmetic consequences of an aggressive extensive craniectomy in patients with hyperostosis of the cranial vault in order to maximize radical tumor resection and decrease recurrences. Several materials have been tried and proposed suitable for cranioplasty. The essence of a successful cranioplasty material is a substance whose physical properties are as close to those of bone as possible, and which can be easily incorporated into skull bones in order to defy infection whether it is a homograft, an autograft, or a heterograft. Among other features, cranioplasty material must be hard enough to protect the brain, resilient enough to be easily shaped, and not brittle so it does not break when exposed to everyday possible minor trauma. It must be nonreactive to the tissue it will be incorporated into, must be nonresorbable, and should not sink easily to ensure long-term cosmetic results. Of course, it must be easily sterilizable and should be able to combat infection. Bone vascularized grafts are ideally preferred if available. Cranial vault defects are easier to manage than complex basal resections, especially of the orbital and facial bones. Simple autoclaving of the calvarial involved bone followed by reshaping may be the least expensive cranioplasty material but it has been associated with few incidences of graft desorption. The autoclaved bone generally forms the scaffold over which osteoblasts and osteoclast would replace and lay new bone material. Split-thickness calvarial grafts have been used successfully to cover traumatic cranial bone defects. Cranioplasty materials should be present in