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Split Calvarial Grafting for Closure of Large Cranial Defects: The Ideal Option?

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Abstract

Among the various cranioplasty options for reconstruction of large post-craniectomy defects, split calvarial grafting offers numerous significant advantages such as the provision of viable autogenous bone graft material comprising of living, immunocompatible bony cells that integrate fully with the skull bone bordering the cranial defect. Its potential for revascularization and subsequent integration and consolidation allows its successful use even in previously infected or otherwise compromised recipient sites. Its excellent contour match at the recipient site and low cost as compared to various alloplastic implant materials often makes it preferable to the latter. Surgeon’s skill, dexterity, expertise and experience are important factors to be considered in this highly technique-sensitive procedure.

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References

  1. Goldstein JA, Paliga JT, Bartlett SP (2013) Cranioplasty: indications and advances. Curr Opin Otolaryngol Head Neck Surg 21:400–409

    PubMed  Google Scholar 

  2. Jiang JY, Xu W, Li WP (2005) Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. J Neurotrauma 22:623–628

    PubMed  Google Scholar 

  3. Bohman LE, Schuster JM (2013) Decompressive craniectomy for management of traumatic brain injury: an update. Curr Neurol Neurosci Rep 13:392–395

    PubMed  Google Scholar 

  4. Stiver SI, Wintermark M, Manley GT (2008) Motor trephine syndrome: a mechanistic hypothesis. Acta Neurochir Suppl 102:273–277

    PubMed  Google Scholar 

  5. Tabaddor K, LaMorgese J (1976) Complication of a large cranial defect. Case report. J Neurosurg 44:506–508

    CAS  PubMed  Google Scholar 

  6. Amorim RL, Bor-Seng-Shu E, Gattás GS, Paiva W, de Andrade AF, Teixeira MJ (2012) Decompressive craniectomy and cerebral blood flow regulation in head injured patients: a case studied by perfusion CT. J Neuroradiol 39:346–349

    PubMed  Google Scholar 

  7. Sakamoto S, Eguchi K, Kiura Y, Arita K, Kurisu K (2006) CT perfusion imaging in the syndrome of the sinking skin flap before and after cranioplasty. Clin Neurol Neurosurg 108:583–585

    PubMed  Google Scholar 

  8. Kemmling A, Duning T, Lemcke L et al (2010) Case report of MR perfusion imaging in sinking skin flap syndrome: growing evidence for hemodynamic impairment. BMC Neurol 10:80–86

    PubMed  PubMed Central  Google Scholar 

  9. Stiver SI, Wintermark M, Manley GT (2008) Reversible monoparesis following decompressive hemicraniectomy for traumatic brain injury. J Neurosurg 109:245–254

    PubMed  Google Scholar 

  10. Jeyaraj P (2015) Importance of early cranioplasty in reversing the “syndrome of the trephine/motor trephine syndrome/sinking skin flap syndrome. J Maxillofacial Oral Surg 14:666–673

    Google Scholar 

  11. Longacre JJ, DeStefano GA (1957) Reconstruction of extensive defects of the skull with split rib grafts. Plast ReconslI Surg 19:186–199

    CAS  Google Scholar 

  12. Ylikontiola LP, Lehtonen V, Sándor GK (2016) Piezo harvesting of bone grafts from the anterior iliac crest: a technical note. Ann Maxillofac Surg 6:94–96

    PubMed  PubMed Central  Google Scholar 

  13. Prolo DJ, Oklund SA (1991) The use of bone grafts and alloplastic materials in cranioplasty. Clin Orthop Relat Res 268:270–278

    Google Scholar 

  14. Inoue A, Satoh S, Sekiguchi K, Ibuchi Y, Katoh S, Ota K (1995) Cranioplasty with split thickness calvarial bone. Neurol Med Chir (Tokyo) 35:804–807

    CAS  Google Scholar 

  15. Tessier P (1982) Autogenous bone grafts taken from the calvarium for facial and cranial applications. Clin Plast Surg 9:531–538

    CAS  PubMed  Google Scholar 

  16. Williams LR, Fan KF, Bentley RP (2015) Custom-made titanium cranioplasty: early and late complications of 151 cranioplasties and review of the literature. Int J Oral Maxillofac Surg 44:599–608

    CAS  PubMed  Google Scholar 

  17. Werndle MC, Crocker M, Zoumprouli A, Papadopoulos MC (2012) Modified acrylic cranioplasty for large cranial defects. Clin Neurol Neurosurg 114:962–964

    PubMed  Google Scholar 

  18. Artico M, Ferrante L, Pastore FS, Ramundo EO, Cantarelli D, Scopelliti D (2003) Bone autografting of the calvaria and craniofacial skeleton: historical background, surgical results in a series of 15 patients, and review of the literature. Sur Neurol 60:71–79

    Google Scholar 

  19. Santonirugiu P (1969) Repair of skull defects by outer table osteoperiosteal free grafts. Plast Reconstr Surg 43:157–161

    CAS  Google Scholar 

  20. Sanan A, Haines SJ (1997) Repairing holes in the head: a history of cranioplasty. Neurosurgery 40:588–603

    CAS  PubMed  Google Scholar 

  21. Valentini V, Cassoni A, Marianetti TM (2007) Reconstruction of craniofacial bony defects using autogenous bone grafts: a retrospective study on 233 patients. J Craniofac Surg 18:953–958

    PubMed  Google Scholar 

  22. Lee C, Antonyshyn OM, Forrest CR (1995) Cranioplasty: indications, technique, and early results of autogenous split skull crartial vault reconstruction. J Crartio Maxfac Surg 23:133–142

    CAS  Google Scholar 

  23. Casanova R, Cavalcante D, Grotting JC, Vasconez LO, Psillakis JM (1986) Anatomic basis for vascularized outertable calvarial bone flaps. Plast Reconstr Surg 78:300–308

    CAS  PubMed  Google Scholar 

  24. Frodel JL (2002) Calvarial bone graft harvesting techniques: considerations for their use with rigid fixation techniques in the craniomaxillofacial region. In: Greenberg A, Prein J (eds) Craniomaxillofacial reconstructive and corrective bone surgery. Springer, New York, pp 700–712

    Google Scholar 

  25. Gema SM, Momen M, Badri AA (2017) Split calvarial graft and titanium mesh for reconstruction of post craniotomy frontal bone defect. Ethiop J Health Sci 28:245

    Google Scholar 

  26. Prolo DJ, Burres KP, McLaughlin WT, Christensen AH (1979) Autogenous skull cranioplasty: fresh and preserved (frozen), with consideration of the cellular response. Neurosurgery 4:18–29

    CAS  PubMed  Google Scholar 

  27. Cutting CB, McCarthy JG (1983) Comparison of residual osseous mass between vascularized and nonvascularized onlay bone transfers. Plast Reconst Surg 72:672–675

    CAS  PubMed  Google Scholar 

  28. Petrochenko P, Narayan RJ (2010) Novel approaches to bone grafting: porosity, bone morphogenetic proteins, stem cells, and the periosteum. J Long Term Eff Med Implants 20:303–315

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Bradley ES, Thomas M (2000) Calvarial bone graft harvest: anew technique. J Otolaryngol Head Neck Surg 123:547–552

    Google Scholar 

  30. Lee HJ, Choi JW, Chung IW (2014) Secondary skull reconstruction with autogenous split calvarial bone grafts versus nonautogenous materials. J Craniofac Surg 25:1337–1340

    PubMed  Google Scholar 

  31. Hayward RD (1999) Cranioplasty: don’t forget the patient’s own bone is cheaper than titanium. Br J Neurosurg 13:490–491

    CAS  PubMed  Google Scholar 

  32. Reddy S, Khalifian S, Flores JM, Bellamy J, Manson PN, Rodriguez ED, Dorafshar AH (2014) Clinical outcomes in cranioplasty: risk factors and choice of reconstructive material. Plast Reconstr Surg 133:864–873

    CAS  PubMed  Google Scholar 

  33. Grant GA, Jolley M, Ellenbogen RG, Roberts TS, Gruss JR, Loeser JD (2004) Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 100:163–168

    PubMed  Google Scholar 

  34. Emerick KS, Hadlock TA, Cheney ML (2008) Nasofacial reconstruction with calvarial bone grafts in compromised defects. Laryngoscope 118:1534–1538

    PubMed  Google Scholar 

  35. Frodel JL, Marentette LJ, Quatela VC, Weinstein GS (1993) Calvarial bone graft harvest techniques, considerations, and morbidity. Arch Otolaryngol Head Neck Surg 119:17–23

    PubMed  Google Scholar 

  36. Power SM, Matic DB, Holdsworth DW (2015) The effects of nonvascularized versus vascularized bone grafting on calvarial defect healing. J Craniofac Surg 26:290–295

    PubMed  Google Scholar 

  37. Ilankovan V, Jackson IT (1992) Experience in the use of calvarial bone grafts in orbital reconstruction. Br J Oral Maxillofac Surg 30:92–96

    CAS  PubMed  Google Scholar 

  38. Wallace RD, Craig MD, Konofaos P (2015) Comparison of autogenous and alloplastic cranioplasty materials following impact testing. J Craniofac Surg 26:1551–1557

    PubMed  Google Scholar 

  39. Fares B, Christian EA (2012) Biomechanical effects of cranioplasty. J craniofac Surg 23:e152–e153

    Google Scholar 

  40. Scloeker B, Trummer M (2014) Prediction parameters of bone flap resorption following cranioplasty with autologous bone. Clin Neurol Neurosurg 120:64–67

    Google Scholar 

  41. Sahoo NK, Roy ID, Desai AP, Gupta V (2010) Comparative evaluation of autogenous calvarial bone graft and alloplastic materials for secondary reconstruction of cranial defects. J Craniofac Surg 21:79–82

    PubMed  Google Scholar 

  42. Sahoo NK, Rangan M (2012) Role of split calvarial graft in reconstruction of craniofacial defects. J Craniofac Surg 23: e1–4

    PubMed  Google Scholar 

  43. Kumar NG, Sudeep S, Balwan R (2015) Cranioplasty of hemispherical defects using calcium phosphate cements along with titanium mesh: our experience. J Maxillofac Oral Surg 14:920–924

    PubMed  PubMed Central  Google Scholar 

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Funding

This study was not funded by any organization/society.

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Authors and Affiliations

  1. Military Dental Centre (Gough Lines), Indian Army, Secunderabad, Telangana, 500015, India

    Priya Jeyaraj

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  1. Priya Jeyaraj
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Correspondence to Priya Jeyaraj.

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The author of this article has not received any research grant, remuneration, or speaker honorarium from any company or committee whatsoever, and neither owns any stock in any company. The author declares that she does not have any conflict of interest.

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This article does not contain any new studies with human participants or animals performed by the author.

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Informed consent was obtained from all the individual participants in this study.

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All procedures performed on the patients (human participants) involved were in accordance with the ethical standards of the institution and/or national research committee, as well as with the 1964 Helsinki declaration and its later amendments and comparable ethical standards.

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Jeyaraj, P. Split Calvarial Grafting for Closure of Large Cranial Defects: The Ideal Option?. J. Maxillofac. Oral Surg. 18, 518–530 (2019). https://doi.org/10.1007/s12663-019-01198-w

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  • DOI: https://doi.org/10.1007/s12663-019-01198-w

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