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Heterotopic ossification following suboccipital craniectomy decompression surgery for Chiari malformation type I:

Christopher E Louie1, Jennifer Hong2, David F Bauer1,2

  • 11Geisel School of Medicine at Dartmouth, Hanover; and.

Journal of Neurosurgery. Pediatrics
|March 30, 2019
PubMed

Insights

A rare complication of duraplasty using autologous pericranium is heterotopic ossification. This bone growth can compress neural structures, requiring reoperation for symptomatic Chiari malformation type I patients.

Area of Science:

  • Neurosurgery
  • Pediatric Neurosurgery
  • Surgical Complications

Background:

  • Suboccipital craniectomy with duraplasty is a standard procedure for symptomatic Chiari malformation type I (CM-I) in children.
  • Autologous pericranium is frequently the preferred dural substitute for duraplasty due to its advantages, including cost-effectiveness and biocompatibility.
  • Long-term data on the durability and potential complications of various dural substitutes, including autologous pericranium, are limited.

Observation:

  • This report details a rare long-term complication of duraplasty using an autologous pericranial graft: heterotopic ossification.
  • Heterotopic ossification involves dystrophic bone growth within the graft material.
  • Such bone formation can lead to symptomatic neural compression, necessitating surgical intervention.

Findings:

  • The study identifies heterotopic ossification of autologous pericranial grafts as a rare but significant long-term complication following duraplasty.
  • Literature review confirms the rarity and potential for symptomatic presentation of this complication.
  • Reoperation is required for the removal of heterotopic bone causing neural compression.

Implications:

  • Neurosurgeons should maintain awareness of heterotopic ossification as a potential long-term complication of pericranial grafts in duraplasty.
  • Patients presenting with atypical symptoms post-duraplasty should be evaluated for this rare complication.
  • Consideration of alternative dural substitutes or careful graft monitoring may be warranted in specific cases.

Keywords:
Chiari I malformationduraplastydystrophic ossificationheterotopic ossificationsyringomyelia

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