Long-term outcome of subcutaneously preserved autologous cranioplasty

Decompressive craniectomy for intracranial hypertension mandates later cranioplasty. Autologous cranioplasties can be preserved either by freezing or placement in a subcutaneous pocket. There are few data on the long-term follow-up of patients treated in such a fashion.

A retrospective study was conducted on 100 consecutive patients who underwent decompressive craniectomy and placement of the bone flap in a subcutaneous pocket in the abdominal wall between 2000 and 2005. Initial diagnosis, Glasgow Coma Scale score on admission, complications, and Glasgow Outcome Score were recorded.

Of the 100 patients who underwent autocranioplasty, the primary diagnosis was traumatic brain injury (76%), subarachnoid hemorrhage (17%), primary intracerebral hemorrhage (3%), and tumor (4%). The mean age of the sample was 39 years (age range, 10-72 years). The mean follow-up duration was 25 months. The average Glasgow Coma Scale score on admission was 7. Eight patients died before replacement of the bone flap. The average time between craniectomy and replacement of bone flap was 42 days. The mean Glasgow Outcome Score was 4 at the time of the 1-year follow-up evaluation. Seven of the 79 patients (9%) for whom 1-year review data were available had a cosmetic result that was unacceptable and required removal of the flap (bone flap infections in 5 patients, unacceptable bone flap resorption in 2 patients)

Our study indicates that storage of a cranioplasty flap in a subcutaneous pouch in the abdominal wall has a favorable long-term outcome.