Free bone flap reconstruction in retrosigmoid approach for microvascular decompression: a comparative cohort study

Area of Science:

• Neurosurgery
• Surgical Techniques

Background:

• Rigid fixation using titanium plates and screws is standard for bone flap fixation after retrosigmoid craniotomy for microvascular decompression (MVD).
• Evaluating alternative fixation methods can optimize patient outcomes and resource utilization.

Purpose of the Study:

• To assess the outcomes and complication rates of free bone flap cranioplasty without fixation in MVD.
• To compare these outcomes with conventional titanium fixation methods.

Main Methods:

• Retrospective review of 189 patients undergoing MVD via retrosigmoid approach from May 2017 to August 2022.
• Patients were divided into two groups: bone flap fixed with titanium or unfixed (free bone flap).
• Follow-up periods ranged from 6 to 28 months.

Main Results:

• The free bone flap group (79 cases) demonstrated significantly shorter operative times (105.56 ± 15.87 min vs. 113.72 ± 17.80 min) and lower in-patient costs (¥23059.66 ± 4488.54 vs. ¥27714.82 ± 2705.74).
• Postoperative headache and incisional pain were less frequent in the free bone flap group (43.0% vs. 60.9%).
• No significant differences were observed in bone flap displacement, hospital stay duration, or overall complication rates between the groups. Long-term CT follow-up confirmed good skull union in all assessed free bone flap cases.

Conclusions:

• Free bone flap cranioplasty without titanium fixation is a viable alternative in MVD procedures.
• This technique effectively reduces operative time and hospitalization costs without compromising safety or increasing complication rates.
• Further research may support wider adoption of this less invasive fixation method.