Recovered bone flap tilting after encephalo-myo-synangiosis: A complication

Abstract

ObjectivesThe aim of this study was to analyze the clinical data concerning the loosening and tilting of the recovered bone flap after encephalo-myo-synangiosis (EMS) and explore the potential underlying mechanisms. Patients and methodsClinical data of all patients who underwent an EMS procedure from January 1, 2014 to April 30, 2018 at our hospital were collected. The cases with postoperative tilting of the recovered bone flap were identified and the clinical characteristics of the patients involved were analyzed. ResultsThere were totally 204 patients who underwent EMS, among whom 12 patients (Male/Female = 6/6) experienced tilting of the recovered bone flap after craniotomy. The average age was 44.3 years. The average height of the tilt was 8.3 ± 3.1 mm. The shortest time for the bone flap to tilt to a height of 5 mm was found to be one day after surgery and the longest was up to 7 months. In cases in which maximum height was observed in a short duration after surgery, the average time for the tilted bone flap to reach the maximum height was 6.1 ± 3.6 days. In addition, a second craniotomy on the opposite side might be an important factor, and three cases were noted with second surgeries (Cases 2, 7, and 9). ConclusionRecovered bone flap tilting after EMS should be listed as a complication after roofing of the temporal muscle. This complication may be related to the temporal muscle edema, the increase of intracranial pressure and no bandage compression.