Cranioplasty of the anterior fossa traumatic bone defect using autologous cancellous bone

Traumatic lesions of the anterior cranial fossa (ACF) with comminuted depressed fractures and with tears of dura require operative management. In reports, the results of surgical treatment (repairing dural defects only) are not quite satisfactory. The cause of recurrent cerebrospinal fluid (CSF) rhinorrhea and/or meningitis in some cases is the neglect in managing the bone defects. Being aware of the importance of the bony part of the ACF, in isolating the intracranial contents from the nasal and/or sinusal cavities, the covering of the midline bone defects on the floor of the ACF is also strongly indicated. We treated four patients with acrylic material and one of them had recurrence of meningitis. Four years ago we started to cover the ACF bone defects using the plates and chips of autologous cancellous bone. Out of a group of 45 patients, 14 were treated closing the dura wounds and obliterating the bone defects. Five of them died of primary cerebral injuries; and in 9 patients (5 operated in acute stage and 4 in chronic stage) the results were excellent.