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Repair of a large congenital frontal bone defect with autologous exchange cranioplasty
Alexander E Ropper1, Gary F Rogers, Emily B Ridgway
1Department of Neurosurgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. aeropper@partners.org
Insights
A large frontal bone defect and sagittal synostosis in a child were successfully repaired using autologous bone grafting and cranial vault expansion. This technique offers a reliable method for correcting significant skull defects.
Area of Science:
- Neurosurgery
- Pediatric Plastic Surgery
- Craniofacial Surgery
Background:
- Idiopathic large frontal bone defects are rare and require complex surgical correction.
- Sagittal synostosis, a premature fusion of the sagittal suture, can lead to cranial narrowing and affect skull development.
Observation:
- A 6-year-old girl presented with a large, midline idiopathic frontal bone defect and diagnosed sagittal synostosis.
- The underlying dura was slightly tense, but the patient showed no signs of increased intracranial pressure.
Findings:
- The frontal bone defect was repaired using autologous corticocancellous bone graft.
- Cranial vault expansion with barrel-stave osteotomies was performed to address sagittal synostosis and cranial narrowing.
- Donor sites were covered with autologous particulate bone graft, which healed effectively.
Implications:
- Autologous exchange cranioplasty with corticocancellous particulate bone graft is a viable and effective technique for repairing large calvarial defects.
- This approach may offer a solution for defects analogous to parietal foramina, potentially sharing similar causes.
- The combined technique addresses both the bone defect and the underlying craniosynostosis, promoting normal skull development.
Abstract:
The authors report the case of a large idiopathic frontal bone defect and concomitant sagittal synostosis corrected by autologous exchange cranioplasty by using a corticocancellous bone graft and cranial vault expansion. An otherwise healthy, developmentally normal 6-year-old girl presented to our clinic with a large frontal bone defect. The osseous defect was midline and inferior to the coronal sutures, and the underlying dura was slightly tense. She had no signs or symptoms of increased intracranial pressure, and her head circumference and cephalic index were normal. Imaging demonstrated fusion of the sagittal synostosis. The defect was repaired using full-thickness autologous bone harvested from the bilateral parietal regions, which were widened using barrel-stave osteotomies to reduce pressure on the graft site in the setting of sagittal synostosis and mild cranial narrowing. The donor sites were covered with autologous particulate bone graft harvested from the endocortical surface of the grafted segments and the ectocortical surface of the intact parietal bones. The donor and recipient sites healed. Imaging revealed that the particulate bone healed with a thickness similar to the surrounding bone. This bony defect is analogous to parietal foramina and may have a similar etiopathogenesis. The technique of autologous exchange cranioplasty using corticocancellous particulate bone graft provides a simple and reliable method to repair large structural calvarial defects.
