An in situ repositioning bone flap in retrosigmoid craniotomy for cranial reconstruction

Osteoplastic craniotomy in retrosigmoid approaches to the cerebellopontine angle region has been suggested as an alternative to traditional osteoclastic craniectomy. It is important both for prevention of postoperative complications and for cosmetic purposes. The authors investigated a safe and effective method of cranial reconstruction by repositioning a 1-step formed bone flap without bone window extension in lateral suboccipital craniotomy.

Twenty-three cases of various cerebellopontine angle pathologies, managed at the Department of Neurosurgery of the Third Affiliated Hospital of Sun Yat-Sen University from January 2011 to November 2011, had bone-flap repositioning at the original site after craniectomy during the same operative setting. All patients had preoperative three-dimensional computed tomography reconstruction of the skull. Anatomical markers were made in three-dimensional images, and individualized bone windows were designed. During operation, a 1-step formed bone flap was made according to the preoperative simulation scheme. After the intradural procedure was completed, the bone flap was repositioned and fixed in situ.

No complication was observed. No delayed postcraniectomy pain occurred to any patient. Postoperative computed tomography scan of the skull showed good healing and shaping of the suboccipital bone at the surgical region.

The present report provides acceptable results both clinically and radiologically. More comparative studies are required to evaluate possible advantages of this technique over osteoclastic craniectomy.