Large Skull Defects Research Articles

Safety of labor, Valsalva maneuver, and neuraxial anesthesia for pregnant women after decompressive craniectomy: Case series and review of the literature.

Decompressive craniectomies are a neurosurgical operation aimed at normalizing intracranial pressure (ICP). Occasionally, there is delayed replacement of the skull resulting in an acquired skull defect. When managing laboring patients with an acquired skull defect there is often fear associated with traditional labor involving the Valsalva maneuver and with neuraxial anesthesia. These fears typically stem from potential ICP changes and risk of herniation. In reviewing the literature, only 15 cases are described detailing labor management after decompressive craniectomy (DC), mostly with incomplete labor histories. We aim to expand that literature by reporting two cases of safe labor with epidural anesthesia in patients with large skull defects. The first described patient underwent a cranioplasty during pregnancy because of trauma. Later, because of concerns for pre-eclampsia, induction of labor was initiated and she received neuraxial anesthesia via epidural. The patient ultimately underwent cesarean delivery 48 h after induction began due to nonreassuring fetal heart tones. The second patient underwent a cranioplasty because of infection prior to pregnancy. Once in labor, she was cleared by neurosurgery and the anesthesia team placed her epidural. She later underwent an uncomplicated standard vaginal delivery. The existing literature on labor following DC is sparse. Retrospective review of case reports can advance discussion and standardization regarding care for laboring women with a history of DC. We advocate that the Valsalva maneuver and epidural anesthesia is safe for pregnant women who are neurologically asymptomatic.

Point-of-Care 3-Dimensional-Printed Polyetheretherketone Customized Implants for Cranioplastic Surgery of Large Skull Defects.

3-Dimensional (3D) printing has become a common tool to aid implant molding for cranioplastic surgery of large skull defects. Until now, 3D printing of cranial implants itself has not been used, mainly because of medicolegal concerns. With a 3D printer developed for printing medical applications and with implant-grade polyetheretherketone (PEEK) filament available, we established a workflow (in compliance with medical device regulations) to 3D print cranial implants for cranioplastic surgery directly at the point of care (POC). Here, we describe the implementation of 3D printing these PEEK implants for cranioplastic surgery at our academic hospital. A thorough design and 3D printing process, in accordance with local medical device regulations, was developed. Implants are digitally designed based upon pre- and post-craniectomy cranial computed tomography scans by trained 3D printing experts from the department of medical engineering at our institution. Implants are then produced on a medical 3D printer with implant-grade PEEK filament using the fused filament fabrication process. After postprocessing and steam sterilization, implantation for reconstruction of the skull can be performed. Cranioplastic surgery with a 3D-printed PEEK implant was performed at our institution in a patient with a large frontotemporoparietal skull defect after traumatic brain injury with consecutive decompressive craniectomy. No intra- or post-operative complications occurred. Postoperative cranial computed tomography scans showed perfect reconstruction of precraniectomy skull shape. The aesthetic result was promising and satisfactory to the patient. This novel 3D printing workflow enables the production of patient-specific cranial implants from PEEK, to reconstruct large skull defects directly at the POC in accordance with the European Medical Device Regulation. This marks an unprecedented technological and legal advancement, enabling the hospital infrastructure not only to deliver the cranioplastic surgery itself, but also additive manufacturing of the implant directly at the POC.

Optimized high-definition tDCS in patients with skull defects and skull plates.

Transcranial direct current stimulation (tDCS) has been shown to benefit patients with brain lesions or traumatic brain injury (TBI). These patients usually have skull defects with different sizes and electrical conductivities. There is very little data in the literature that show how to optimally stimulate these patients with the presence of skull defects. Here we leveraged high-resolution (1 mm) realistic head models to explore the best montages targeting right beneath the skull defects with different sizes and conductivities. Specifically, open-source software ROAST was used to solve for the lead field on the publicly available MIDA model. Four different skull defects/plates were modeled with the center above the right primary motor cortex: a larger defect (10 cm diameter) modeled as either titanium or acrylic plate, and a smaller defect (2.5 cm diameter) modeled as either acute state filled with cerebrospinal fluid (CSF) or chronic state with scar tissue. Optimized stimulation with maximal intensity was run using ROAST targeting the right primary motor cortex. We show that optimized high-definition montages can achieve an average of 0.3 V/m higher stimulation intensities at the target compared to un-optimized montages (M1-SO or 4×1). Large skull defects with titanium or acrylic plates significantly reduce the stimulation intensity by about 80%, while small defects with acute (CSF) or chronic (scar) tissues significantly increase the stimulation intensity by about 200%. Furthermore, one can use M1-SO to achieve almost the same stimulation strength as the optimized montage if the skull has a large defect with titanium plate, and there is no significant difference in stimulation intensity between 4×1 montage and the optimized montage for small skull defects with scar tissue. Based on this work, future modeling studies leveraging individual anatomy of skull defects may help guide tDCS practice on patients with skull defects and skull plates.

Customized External Cranioplasty for Management of Syndrome of Trephined in Nonsurgical Candidates.

Craniectomies represent a lifesaving neurosurgical procedure for many severe neurological conditions, such as traumatic brain injury. Syndrome of trephined (SoT) is an important complication of decompressive craniectomy, and cranial reconstruction is the definitive treatment. However, many patients cannot undergo surgical intervention because of neurological status, healing of the primary surgical wound, or the presence of concurrent infection, which may prevent cranioplasty. To offer a customized external cranioplasty option for managing skull deformities for patients who could not undergo surgical intervention for definitive cranioplasty. We describe the design and clinical application of an external cranioplasty for a patient with a medical history of intractable epilepsy, for which she underwent multiple right cerebral resections with a large resultant skull defect and SoT. The patient had resolution of symptoms and restoration of a symmetrical skull contour with no complication at 17 months. Customized external cranioplasty can improve symptoms associated with SoT for patients who cannot undergo a definitive cranioplasty. In addition, inset monitoring options, such as electroencephalography or telemetric intracranial pressure sensors, could be incorporated in the future for comprehensive monitoring of the patient's neurological condition.

Design and mechanical evaluation of a large cranial implant and fixation parts

Cranial implants are designed based on patient Digital Imaging and Communications in Medicine data. An asymmetric approach is usually employed to design cranial implants, and fixation plates are used to fix the implant. In this study, the use of numerical simulation of 3D (3 Dimension) cranial implants made from Polyether Ether Ketone was investigated. A skull defect reconstruction was conducted using Computer-Aided Design and 3D printing software to evaluate the durability of the implant, increase the surgical accuracy, and reduce surgical costs and risks. The large skull patch was designed by reverse engineering. The subtraction method was applied based on a healthy skull prototype. The large cranial implants on the two halves of the skull were asymmetrical and included fixation parts. Using the finite element method, the asymmetric defect skull model was simulated under intracranial pressures and a static load of 50 N placed at three positions. The results are shown through displacement, stress, and elastic deformation. The cranial implants were implanted, ensuring the material’s durability, and improving the patient’s aesthetics. In this study, a cranial implant design and evaluation method for large skull defects reduces the time and risk of surgery. Generous size skull pieces can be fabricated in compliance with specific design criteria. The design of the cranial implant met the basic operating conditions of the patient through the finite element method. The cranial implants were fabricated by injection molding and successfully implanted into the patient.

Cranial defect and pneumocephalus are associated with significant postneurosurgical positional brain shift: evaluation using upright computed tomography

Only few studies have assessed brain shift caused by positional change. This study aimed to identify factors correlated with a large postneurosurgical positional brain shift (PBS). Sixty-seven patients who underwent neurosurgical procedures had upright computed tomography (CT) scan using settings similar to those of conventional supine CT. The presence of a clinically significant PBS, defined as a brain shift of ≥ 5 mm caused by positional change, was evaluated. The clinical and radiological findings were investigated to identify factors associated with a larger PBS. As a result, twenty-one patients had a clinically significant PBS. The univariate analysis showed that supratentorial lesion location, intra-axial lesion type, craniectomy procedure, and residual intracranial air were the predictors of PBS. Based on the multivariate analysis, craniectomy procedure (p < 0.001) and residual intracranial air volume (p = 0.004) were the predictors of PBS. In a sub-analysis of post-craniectomy patients, PBS was larger in patients with supratentorial craniectomy site and parenchymal brain injury. A large craniectomy area and long interval from craniectomy were correlated with the extent of PBS. In conclusion, patients who undergo craniectomy and those with residual intracranial air can present with a large PBS. In post-craniectomy patients, the predisposing factors of a large PBS are supratentorial craniectomy, presence of parenchymal injury, large skull defect area, and long interval from craniectomy. These findings can contribute to safe mobilization among postneurosurgical patients and the risk assessment of sinking skin flap syndrome.

Customized alloplastic cranioplasty of large bone defects by 3D-printed prefabricated mold template after posttraumatic decompressive craniectomy: A technical note.

Background: Manufacturing of customized three-dimensional (3D)-printed cranioplastic implant after decompressive craniectomy has been introduced to overcome the difficulties of intraoperative implant molding. The authors present and discuss the technique, which consists of the prefabrication of silicone implant mold using additive manufacturing, also known as 3D printing, and polymethyl methacrylate (PMMA) implant casting.Methods: To reconstruct a large bone defect sustained after decompressive craniectomy due to traumatic brain injury (TBI), a 3D-printed prefabricated mold template was used to create a customized PMMA implant for cranial vault repair in five consecutive patients.Results: A superb restoration of the symmetrical contours and curvature of the cranium was achieved in all patients. The outcome was clinically and cosmetically favorable in all of them.Conclusion: Customized alloplastic cranioplasty using 3D-printed prefabricated mold for casting PMMA implant is easy to perform technique for the restoration of cranial vault after a decompressive craniectomy following moderate-to-severe TBI. It is a valuable and modern technique to advance manufacturing of personalized prefabricated cranioplastic implants used for the reconstruction of large skull defects having complex geometry. It is a safe and cost-effective procedure having an excellent cosmetic outcome, which may considerably decrease expenses and time needed for cranial reconstructive surgery.

Non-destructive evaluation of patient-specific cranial implants using microcomputed tomography

The combination of computer – aided design (CAD) techniques based on computed tomography (CT) data support the planning of patient – specific implants massively. During the last decade, Geometric Morphometric (GMM) methods utilizing thin – plate splines (TPS) were increasingly used to estimate missing data in clinical cases that are characterized by large skull defects featuring partly and completely missing midsagittal planes. Applying a dedicated reconstruction protocol, GMM methods enable the design of personalized cranial implants that accurately reproduce the bone thickness of the affected area. In this study we applied a TPS based reconstruction approach to design a cranial implant of a clinical case that features the bone thickness distribution in the affected region. This virtual model was subsequently additively manufactured (AM) by fused filament fabrication (FFF) using polyetheretherketone (PEEK). The 3D - printed implant was non – destructively investigated via X-ray microcomputed tomography (XCT). The nominal – actual comparison between the designed virtual model and XCT scan of the final implant showed an average deviation in terms of root mean square (RMS) error of 0.168 mm. Additionally, a pore analysis of the 3D printed implant was carried out showing a porosity of 0.07%.

Neglected Growing Skull Fracture: Details on Peroperative Findings and Surgical Repair

Growing Skull Fracture (GSK) is a rare but significant complication of pediatric head trauma. It commonly develops after a head trauma with a linear skull fracture and an underlying dural tear. Delayed diagnosis and improper management can lead to severe complications. Few reports provide details on peropeartive findings and surgical management of GSF. Herein we report the case of a neglected growing skull fracture in a 2-year-old infant who suffered from an abuse head trauma at the age of three months. A progressive bulging at the site of the fracture was neglected by the family for months. CT scan of the brain showed gliotic brain tissue herniated through a large ragged skull defect. Surgery was indicated and the goals of operation were to remove safely nonviable herniated brain tissue and to protect the neural elements by restoring dural and bone defect. Surgery should be performed acutely in children with GSF to reduce the morbidity and improve outcome.

Cranial Implant Design Applying Shape-Based Interpolation Method via Open-Source Software

Reconstructing a large skull defect is a challenge, as it normally involves the use of sophisticated proprietary image processing and expensive CAD software. As an alternative, open-source software can be used for this purpose. This study aimed to compare the 3D cranial implants reconstructed from computed tomography (CT) images using the open-source MITK software with commercial 3-matic software for ten decompressive craniectomy patients. The shape-based interpolation method was used, in which the technique of segmenting every fifth and tenth slice of CT data was performed. The final design of patient-specific implants from both software was exported to STL format for analysis. The results of the Kruskal–Wallis test for the surface and volume of cranial implants designed using 3-matic and the two MITK techniques showed no significant difference, p &gt; 0.05. The results of the Hausdorff Distance (HD) and Dice Similarity Coefficient (DSC) analyses for cranial implants designed using 3-matic software and the two different MITK techniques showed that the average points distance for 3-matic versus MITK was 0.28 mm (every tenth slice) and 0.15 mm (every fifth slice), and the similarity between 3-matic and MITK on every tenth and fifth slices were 85.1% and 89.7%, respectively. The results also showed that the open-source MITK software is comparable with the commercial software for designing patient-specific implants.

Material of Choice in Pediatric Cranioplasty

Abstract Background Current evidence is lacking regarding the optimum material required for cranioplasty in the pediatric population when native bone cannot be replaced. The aim of our survey was to examine current practice in Australia and New Zealand regarding pediatric cranioplasty material. Methods The online tool SurveyMonkey was used to survey 244 neurosurgeons in Australasia. The survey consisted of five questions concerning preference of material and donor origin for pediatric cranioplasty. Results Twenty-two neurosurgeons (9%) participated. The results indicate that with small skull defects (&lt; 3 cm) in patients aged 0 to 2years, conservative management with observation alone is the preferred option (65%). In patients aged 3 to 10 years, autologous donor bone was the most popular option, whereas for 11+ years, hydroxyapatite (HA) was the material of choice, followed by titanium. For defects of more than 3 cm, autologous donor bone was preferred in under 11 years. In patients older than 11 years, titanium was the preferred choice (46.67%). The preferred donor origin for autologous cranioplasty in small skull defects (&lt; 3 cm) was split calvarial grafts for all age groups. However, 68.42% of respondents managed those under 2 years conservatively. In large skull defects (&gt; 3 cm), the preferred donor origin was split calvarial grafts for patients older than 3 years (48.3%). In patients aged 0 to 2 years, exchange cranioplasty was the preferred option when cranioplasty was performed. Conclusion The current practice in Australia and New Zealand is to use autologous donor bone in preference to synthetic materials for cranioplasty in children under 11 years. In children older than 11 years, hydroxyapatite and titanium are the materials of choice.

Simulating Expansion of the Intracranial Space to Accommodate Brain Swelling after Decompressive Craniectomy: Volumetric Quantification in a 3D CAD Skull Model with Contour Elevation

Background: Decompressive craniectomy (DC) can be used to augment intracranial space and halt brainstem compromise. However, a widely adopted recommendation for optimal surgical extent of the DC procedure is lacking. In the current study, we utilized three-dimensional (3D) computer-assisted design (CAD) skull models with defect contour elevation for quantitative assessment. Methods: DC was performed for 15 consecutive patients, and 3D CAD models of defective skulls with contour elevations (0–50 mm) were reconstructed using commercial software. Quantitative assessments were conducted in these CAD subjects to analyze the effects of volumetric augmentation when elevating the length of the contour and the skull defect size. The final positive results were mathematically verified using a computerized system for numerical integration with the rectangle method. Results: Defect areas of the skull CAD models ranged from 55.7–168.8 cm2, with a mean of 132.3 ± 29.7 cm2. As the contour was elevated outward for 6 mm or above, statistical significance was detected in the volume and the volume-increasing rate, when compared to the results obtained from the regular CAD model. The volume and the volume-increasing rate increased by 3.665 cm3, 0.285% (p < 0.001) per 1 mm of contour elevation), and 0.034% (p < 0.001) per 1 cm2 of increase of defect area, respectively. Moreover, a 1 mm elevation of the contour in Groups 2 (defect area 125–150 cm2) and 3 (defect area >150 cm2, as a proxy for an extremely large skull defect) was shown to augment the volume and the volume-increasing rate by 1.553 cm3, 0.101% (p < 0.001) and 1.126 cm3, 0.072% (p < 0.001), respectively, when compared to those in Group 1 (defect area <125 cm2). The volumetric augmentation achieved by contour elevation for an extremely large skull defect was smaller than that achieved for a large skull defect. Conclusions: The 3D CAD skull model contour elevation method can be effectively used to simulate the extent of a space-occupying swollen brain and to quantitatively assess the extent of brainstem protection in terms of volume augmentation and volume-increasing rate following DC. As the tangential diameter (representing the degree of DC) exceeded the plateau value, volumetric augmentation was attenuated. However, an increasing volumetric augmentation was detected before the plateau value was reached.

Cranioplasty using Titanium Mesh Versus Acrylic Bone Cement: Short-term Outcomes and Complications

Background: Cranioplasty is a reconstructive procedure to restore bone anatomy and repair skull defects. Optimum reconstruction could be a challenge for neurosurgeons, and therefore the strategy to attain the ideal result remains a subject of discussion. Aim: we aimed at comparing two completely different prostheses in reconstructing calvarial bone defects, titanium mesh and polymethyl methacrylate (PMMA) bone cement. We looked for the differences in the cosmetic and functional outcomes as well as the prosthesis-related complications. Patients and Methods: This was a randomized prospective study on the first forty successive adult patients with calvarial skull defects of different etiologies, sites and sizes admitted and operated upon at neurosurgery department, Minia University hospital between January 2017 and December 2018. We divided patients into 2 groups, Group1: 20 patients were operated upon using Titanium mesh and Group 2: 20 patients were operated upon using (PMMA) acrylic bone cement implants. Results: Regarding cosmetic appearance, functional outcome, and improvement of the clinical symptoms (syndrome of trephined), Cranioplasty using titanium mesh and acrylic bone cement proved to have non-significant differences in the reconstruction of calvarial skull defects of different etiologies. However, there is a statistically significant difference between both materials regarding complications especially with large skull defects (≥25 cm2). Conclusion: there is no statistical difference between both materials regarding cosmetic and functional outcomes. However, large bone defects (≥25 cm2)are better treated with titanium mesh due to lower incidence of complications.

A Customized Technique of Cranioplasty for Patients with Large Skull Defects: A Technical Note

In our technical note, we have presented a technique of cranioplasty for large skull defects. A thin-slice computed tomography scan is performed. A model of the skull is constructed using a desktop 3-dimensional printer from the computed tomography scan. The skull model is filled with towels of soft cotton and inserted in a sterile thin plastic bag. The implant is molded intraoperatively on the skull model under sterile conditions. After surgical exposure of the skull defect, the implant is inserted and fixed using miniplates and miniscrews. The technique was used in 6 patients and described in 2 representative cases. The required time and cost are significantly lower than those for other techniques used for preoperative manufacture of implants. No technique-related complications occurred. The radiological and cosmetic results were satisfactory. In the present case series, no early or delayed complications occurred. The presented technique is simple, safe, and time- and cost-effective. The technique and results are reproducible.

Reconstruction of skull and dural defects using anterolateral thigh flaps: A STROBE-compliant article.

It is difficult to repair large skull and dural defects. We observed the therapeutic effects of anterolateral thigh flaps with vascular fascia lata for repairing large skull and dural defects.From December 2008 to June 2019, we repaired large skull and dural defects for 28 cases including 12 cases with scalp malignant tumor and 16 cases requiring removal of titanium mesh which had been once placed due to craniocerebral trauma. The scalp malignant tumor invaded full-thickness skull in 12 cases; and invaded cervical lymph nodes, dura mater or brain tissue in 3 cases. In the 12 cases with scalp malignant tumor, the scalp defects of 12 cm × 9 cm to 22 cm × 18 cm and skull defects of 9 cm × 7 cm to 15 cm × 12 cm after radical tumor resection were repaired using anterolateral thigh flaps of 14 cm × 11 cm to 23 cm × 19 cm with fascia lata of 10 cm × 8 cm to 16 cm × 12 cm. Postoperative radiotherapy and chemotherapy were also performed in the 3 cases with tumor metastasis. In the 16 cases requiring removal of titanium mesh, the skull and dural defects of 8 cm × 7 cm to 15 cm × 11 cm after removal of titanium mesh were repaired using anterolateral thigh flaps of 10 cm × 8 cm to 16 cm × 12 cm.In all cases, the transplanted anterolateral thigh flap with fascia lata survived after surgery and no vascular crisis occurred. During the followup of 8 months to 9 years, the flap appearance in the head-repaired area was fine, no external hernia of brain tissue occurred, the appearance of the femoral donor site was acceptable, and femoral muscle strength and movements were normal in all cases. The 12 cases with scalp malignant tumor had no local recurrence or distant metastasis.Repairing the skull and dural defects caused by radical surgery for scalp malignant tumor or removal of titanium mesh using anterolateral thigh flaps with vascular fascia lata, is effective. The appearance in the head-repaired area is fine without external hernia of brain tissue.

Surgical Management of Sinus Pericranii With Crouzon Syndrome.

Sinus pericranii (SP) is a rare vascular malformation which connects the intracranial dural sinuses to the extracranial venous drainage system. Although the majority of SP cases are caused by trauma, some of them are congenital. Furthermore, a few SP cases have been reported in association with craniosynostosis. The authors' objective is to discuss the surgical management of SP with Crouzon's syndrome in children. Three-Dimensional reconstruction with enhanced CT scan was used for evaluate the condition of SP with Crouzon's syndrome in all 4 cases. Two cases with small single-hole defect on skull were only treated by cranioplasty with distraction osteogenesis. In the management of the other 2 SP patients with large skull defect, titanium mesh was used for compression of dilated venous sinus to inhabit filling and promote shrinking. Four cases of SP with Crouzon's syndrome were treated in the authors' department. With cranioplasty with distraction osteogenesis only, 2 patients with single-hole skull defect experienced SP spontaneous involution at 4 to 6 months postoperatively. With titanium mesh compression, SP with large skull defect shrank significantly without clinical recurrence, but long-term follow-up was still in need. For small single-hole skull defect in SP patient with Crouzon's syndrome, the only application of cranioplasty for decreasing intracranial pressure can promote SP spontaneous involution. 3D printed titanium mesh compression renders a safe and efficient approach for SP with large skull defect. Long-time follow up and further accumulation of cases may establish the efficacy of the authors' management.

A New Type of Three-Dimensional Customized Composite Implant in Reconstruction of Large Skull Defects.

Large skull defects can result in chronic injury to intracranial tissues as well as psychological trauma for patients, and their repair presents a challenge to surgeons. Hydroxyapatite has been used in reconstructing skull defects for many years, but it is difficult to adjust the shape and size of the material intraoperatively, especially for large defects. With three-dimensional digital technology, a new type of customized composite implant made of epoxide acrylate maleic and hydroxyapatite has been applied in clinical practice. In this retrospective review, 15 patients with large skull defects (4 female and 11 male, at a mean age of 36.4 years, range from 24-65 years) were treated with the novel customized composite implant, reconstructing the large skull defects successfully. During the average 2.2 years follow-up period (range 0.5-4 years), complications including infection, cerebrospinal fluid leakage, intracranial hemorrhage, or implant exposurea were not occured, only 1 patient (6.7%) with a seroma managed non-operatively. The customized implants, which required no intraoperative adjustments and are about a third of the cost of titanium implants, are an excellent alternative for large skull defect repair.

Neuronavigation in Reconstructive Surgery of a Large Skull Defect after Decompressive Craniectomy: Case Report

Neuronavigation in Reconstructive Surgery of a Large Skull Defect after Decompressive Craniectomy: Case Report

An elastic auto-bone patch for one-step repair large skull defects accompanied by Craniocerebral injury

Large area skull defects accompanied by craniocerebral injury are life-threating diseases that are difficult to treat due to the large area of damage and intracranial hypertension. An autologous bone is an ideal source for the regeneration of bone, including skull defects. However, two-step treatment, including craniectomy and cranioplasty, is the main strategy in clinical practice to stabilize intracranial pressure, but still remains a huge obstacle in both the preservation of auto-bone fragments and protection of exposed brain tissue. In this study, an elastic auto-bone patch was developed to provide a new and one-step method for repairing large skull defects which are currently repaired with two stages of surgery. The elastic auto-bone patch is formed by bonding auto-bone fragments together using hydrogels, which is then re-implanted to bone defects to repair large skull defects. The auto-bone patch could adapt to changes in intracranial pressure to protect brain tissue for damage, integrate well with surrounding bone tissues, and promote bone regeneration. After 8 weeks implantation, the large-size skull defect is filled with new formed bone tissues in the group of treating with auto-bone patch. This study introduced a new procedure on the application of elastic auto-bone patch to repair large area skull defects.

Establishment and Characteristic Analysis of a Dog Model for Autologous Homologous Cranioplasty.

Objective The aim of this study is to establish a large animal (dog) model that can be referred clinically for autologous homologous cranioplasty. Methods Our large skull defect dog model was established by emulating the decompressive craniectomy with 22 adult beagle dogs. The autologous bones were taken out from the dogs and divided into two groups, the freeze-drying (FD) group and the single freezing (SF) group. They were then stored in the bone bank at -20°C after being irradiated with 25 KGy. Three months later, the bones were reimplanted. After operation, we closely watch the experimental objects for four more months examining the infection and survival of the bone graft. Results Through macroscopic observation, it was found that, among 44 cranial flaps (bilateral) from the rest of the 22 dogs, grade A cranial flaps accounted for 86.4% (19/22) in the SF group and only 31.8% (7/22) in the FD group. Although osteogenic osteoclast, Harvard tube, neovascularization, and angiogenic factors were found through the pathological results, including an electron microscope and calmodulin tracer, it could be verified by using X-CT and micro-CT that early bone resorption could be still found even in grade A bone flap. Conclusion By using the common clinical method to preserve the cranial flaps, we established an experimental dog model of autologous cranioplasty for a large area of cranial defect. It was proved that this model could reproduce the infections and bone resorption which typically happened in clinical autologous homologous cranioplasty. As a conclusion, the established model can be used as an effective experimental tool for further research to improve the success rate of autologous homologous cranioplasty.