Split-thickness Calvarial Graft Research Articles

Open and endoscopic excision of calvarial dermoid and epidermoid cysts: a single center experience on 128 consecutive cases.

Dermoid and epidermoid cysts rank among the most common pediatric tumors. We analyzed the outcomes of surgical excision of dermal and epidermal inclusion cysts in a large consecutive series of children. We retrospectively reviewed 128 consecutive children who underwent calvarial inclusion cyst resection between 2000 and 2010 at NYU Langone Medical Center. Demographic information, neurological exam, lesion location, lesion diameter, type of treatment, extent of resection, time of follow-up, and recurrence were collected. The cohort includes 67 girls (52.3%) and 61 boys (47.7%). Age at diagnosis ranged from birth to 6.5years (mean of 1.2years) with surgical intervention between 1month and 20years of age (1.5±2.1). Of the 128 patients, 107 underwent open resection. Surgical approach was determined by the senior surgeon. Location, postoperative cosmesis, and family preference were the determining factors. Endoscopic resection was favored with supraorbital and glabellar lesions (75% endoscopic versus 25% open) using a rigid scope via a single incision. Erosion of the outer table and involvement of the inner table was noted in 20 patients (15%), 14 of which were reconstructed using a split thickness calvarial graft. These lesions were noted to be significantly larger than lesions where cranioplasty was not used (1.9±2.81cm versus 1.23±0.98cm, p=0.022). Gross total resection was achieved in all cases. Complete removal and cure from dermoid and epidermoid inclusion cysts are possible. Complications are few. Endoscopic approaches are useful to improve cosmesis and limit tissue damage for lesions near the orbits.

Efficacy of Autogenous Split Thickness Calvarial Graft in the Management of Residual Cranial Defect.

The patients with cranial deformity suffer from headache, dizziness, irritability, loss of concentration, depression, anxiety, intolerance to noise and vibration and neuromotor weakness. It is therefore essential to restore the calvarium. This study was conducted in the Department of Oral and Maxillofacial Surgery, Armed Forces Medical College, Pune between Oct 2010 and Mar 2012. The study population was selected from the outpatient department and from the referred cases. The aim was to study the uptake of split thickness calvarial graft in the management of residual cranial defect. After applying the inclusion and exclusion criterions, ten cases were selected with residual cranial deformity, operated for cranioplasty using split thickness calvarial graft and evaluated. It was concluded that cranioplasty using autogenous split thickness calvarial graft for restoring cranial defects is a useful technique and this procedure allows the surgeon to reconstruct a moderate-to-large cranial defect, without breaching the inner cortical plate.

Role of Split Calvarial Graft in Reconstruction of Craniofacial Defects

The aim of this study was to evaluate the clinical applications, graft uptake, and complications of split-thickness calvarial graft for the reconstruction of craniofacial defects.This retrospective study included 26 patients with craniofacial defects treated between January 2008 and December 2009. This included 17 male and 09 female patients between 9 and 45 years. Depending on the treatment provided, the patients were divided into 3 groups. Group 1 included 11 patients with cranial defect operated on for cranioplasty. Group 2 included 7 patients with orbital floor defect operated on for orbital floor reconstruction, and group 3 included 8 patients with alveolar cleft defect operated on for secondary alveolar grafting. Clinicoradiologic follow-up ranged from 18 to 24 months.In group 1, the symmetry of the calvarium was restored with good cosmesis. Improvement in neurologic function was observed in 7 patients. In group 2, the orbital volume and ocular function was maintained. In group 3, graft uptake was satisfactory with increase in bone density, and continuity of the alveolar bone was maintained. Cuspid eruption was aided orthodontically.Split calvarial grafts are suitable materials for craniofacial reconstruction. Their embryological origin, thickness, and shape are ideal for the restoration of craniomaxillofacial defects.

In Situ Reconstruction of Parietal Bone Craniectomy After Convexity Meningioma Resection

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

Demineralized Bone Matrix and Resorbable Mesh Bilaminate Cranioplasty: A Novel Method for Reconstruction of Large-Scale Defects in the Pediatric Calvaria

Pediatric patients with large-scale calvarial defects often lose the osteogenic potential of their dura before developing a diploic space sufficient to facilitate harvest of split-thickness calvarial grafts. The authors present their experience using demineralized bone matrix and resorbable mesh bilaminate for the repair of large-scale cranial defects in pediatric patients. A retrospective review of the Cleft-Craniofacial Center database at Children's Hospital of Pittsburgh was performed from 2003 through 2007. Patients who underwent cranioplasties using demineralized bone matrix and resorbable mesh bilaminate were identified. Indications, defect size, quantity of demineralized bone matrix used, complications, follow-up, and computed tomographic scans were reviewed. Eleven patients underwent 13 skull reconstructions using demineralized bone matrix and resorbable mesh bilaminate cranioplasty. Mean age was 3.6 years (range, 2.1 to 4.9 years); average defect size was 30.8 cm (range, 6.6 to 80.0 cm). Mean clinical follow-up was 29.3 months (range, 13.4 to 41.8 months). All patients had follow-up computed tomographic scans. The average time of follow-up scan was 18.7 months postoperatively (range, 6.9 to 32.6 months). Seven patients had immediate postoperative scans in addition to long-term follow-up scans, facilitating the calculation of a 98 percent average defect healing (range, 95 to 100 percent). All patients had clinically stable cranial reconstructions at follow-up. When autogenous bone is not available, demineralized bone matrix and resorbable mesh bilaminate cranioplasty is an alternative method of calvarial reconstruction when used in a healthy site free of scarring or infection. This cranioplasty technique has provided consistent bony regeneration, with no donor-site morbidity.

Cranial Thickness in Superior Canal Dehiscence Syndrome

To use morphometric analyses of cranial thickness to investigate 2 cases of unanticipated calvarial bone resorption in superior canal dehiscence (SCD) resurfacing surgery. Retrospective morphometric analysis of high-resolution computed tomography (CT) temporal bone scans in normal and control subjects with accompanying case reports. Tertiary care referral center. Two patients with SCD and failed resurfacing because of bone resorption. Temporal bone CT scans from 30 sex-matched controls. Resurfacing of SCD via a middle fossa approach using a split thickness calvarial graft from the craniotomy site. Mean cross-sectional area of the middle fossa craniotomy bone flap and mean cranial thickness at 30 and 45 degrees above the middle fossa floor. Two patients had delayed failure of SCD resurfacing surgery as manifested by return of symptoms. High-resolution CT scans in both, and intraoperative confirmation in one, confirmed resorption of the bone graft. Measurements of cross-sectional area of the middle fossa craniotomy on high-resolution CT scans demonstrated significantly reduced values in the two SCD patients as compared with normal controls (Mann-Whitney U test, p<0.05). Cranial thickness outside the squamous temporal bone was reduced but did not reach statistical significance. Morphometric measurements of the calvarium have demonstrated that the squamous temporal bone is thinner in patients with SCD as compared with controls. Thus, the process leading to defects in the tegmen extends beyond the petrous pyramid. This suggests that there may be extratemporal factors leading to the development of a dehiscence. These findings also have implications for the surgical treatment of this disorder. Resurfacing methods may have a higher failure rate as the bone graft has reduced mass and maybe prone to resorption. Canal plugging methods may provide a more definitive means of addressing the dehiscent labyrinth than resurfacing.

Outer Table Graft in Middle Fossa Surgery

We describe a surgical technique in which the middle fossa craniotomy ordinarily used for facial nerve decompression and related surgery is extended superiorly to allow the harvest of a split-thickness calvarial graft. This graft allows the tegmen defect in middle fossa surgery to be repaired without shortening the original craniotomy plate. Avoiding the usual temporoparietal depression after middle cranial fossa surgery is both a structural and cosmetic benefit for the patient.