|
African Journal of Neurological Sciences
Pan African Association of Neurological Sciences
ISSN: 1015-8618
Vol. 16, Num. 2, 1997
|
CRANIOPLASTY WITH INNER TABLE OF BONE FLAP IN CHILDREN:
REPORT OF TWO CASES
Afri.J. Neur. Sci. Vol.16 No.2 July 1997
CRANIOPLASTY WITH INNER TABLE OF BONE FLAP IN CHILDREN:
REPORT OF TWO CASES
R.F. RUBERTl
African Neurological Diseases. Research Foundation - Nairobi,
Kenya.
Code Number:NS97009
SUMMARY
Cranioplasty is performed with various
materials and autogenous bone. Since 1956 the Author has adopted
the cranioplasty with acrilic resin in 149 consecutive cases and is
satisfied with this technique in adult patients. less so in
children where, due to the growing of the head and growing of the
bone around the skull defect the acrilic cranioplasty can be
displaced with bad cosmetic results so much that often it requires
redoing. For this reasons the Author has adopted recently the
cranioplasty with inner table of bone flap as described by KAZUHIKO
et al in 1985. This technique has been used to repair the skull
detect in two children with very satisfactory results. It is worth
reporting this method of grafting applicable in various situations.
particularly in children and especially. in Africa where acrilic
resin may not be available.
RESUME
Les cranioplasties sont eflectuees avec
differents materiaux et avec de l'os autogenique. Depuis 1956.
l'auteur a utilise dans 149 cas la resine acrylique avec
satisfaction chez les adultes. Chez les enfants. par contre. en
raison de la croissane du crane. la cranioplastie acrylique peut se
deplacer. de telle sorte qu'il taut souvent la retaire. C'est
pourquoi l'auteur a recemment utilise la table interne de l'os
comme lambeau. selon la technique decrite par KAZUHIKO et al en
1985. Elle a ete utilisee chez deux entants avec d'excellents
resultats. En outre. ce type de grefle peut etre utilise dans
differents cas chez les entants. tout particulierement en Atrique
ou la resine acrylique n'est pas touiours disponible.
Key words: Cranioplasty - autogenous bone
children.
The cranioplasty is performed with autogenous
bone and other materials. Whilst the autogenous bone graft is more
physiological. it has various inconveniences mainly in the repair
of large skull defects, the donor place (tibia, ribs, scapula and
iliac bone) that results at the end cause of more problems that the
actual cranioplasty, is more traumatizing, time consuming,
prolonged hospitalization. In the last decades the preference has
been given to the cranioplasty with acrilic resin that has the
following advantages: is a simple technique not requiring long time
to perform, possibility of modelling perfectly and insert directly
the cranioplasty using as mould the skull defect. good tissue
tolerance. The material is insulating, avoid the inconveniences of
heating. is radiotranslucent. does not modify the EEG. low cost
compared with other materials. possibility to pertform in any
moment without any special preparation, a cranioplasty with good
cosmetic results of any skull detect. large or small or irregular.
These are the reasons why since 1956 the cranioplasty with acrilic
resin has been performed by the Author in 149 consecutive cases.
While this technique is satistactory in the adults. is less so in
children where due to the growing of the head and of the bone
around the skull detect. the cranioplasty may be displaced with bad
cosmetic results so much that often it requires redoing. For this
reason it has been recently adopted the cranioplasty with inner
table of bone flap as described by KAZUHIKO et al in 1985. in two
children 6 and 8 years old with very satistactory results.
Case 1.
This 6 year old female was hit on the head in Rwanda in May.
1994. Had a depressed skull fracture and the depressed bone was
removed by a local surgeon. She had a circular bone detect of the
diameter of 5 cm in the right occipital region, well pulsating. No
neurological deficits. On the 22nd November. 1995 a large bone
dowel was taken in the parietal area and the bone was splitted with
a chisel. Replacement of the cortical bone at the donor site and
placement of the inner table at the level of the skull detect. Both
bone flaps were fixed with chromic catgut. Closure in layers over
suction drain. The post operative course was uneventful. Cosmetic
results were excellent. The post operative x-rays some months later
showed good results of grafting.
Case 2.
This 8 year old male was hit in the right
parietal region in May, 1994 in Rwanda. Had a depressed skull
fracture with a mild left hemiparesis. On the 29th November, 1995
the depressed skull was removed. A bone flap was performed in the
right occipital area and the inner table ciseled out to repair the
bone defect. Replacement of the cortical
bone flap in the donor place and fixing of both
bone flaps with chromic catgut. Closure in layers over suction
drain. The post operative course was uneventful. The post operative
x-rays six months later showed a good result of the grafting.
Discussion
Despite the autogenous bone is the most
suitable material for cranioplasty because of its anatomical
similarity to the skull, the use of the standard acrilic
cranioplasty remains at present the procedure used by most
neurosurgeons. This is mainly due to the fact that the bone is
rigid and it can be difficult to contour the graft with respect to
skull defect, surgery and possibility of infection and pain at the
door site, time consuming and other reasons that have made the
autogenous bone for cranioplasty less and less popular. On the
other hand, in children the use of standard acrilic cranioplasty
has some disadvantages due to the growing of the child's head with
possibility of displacement of the cranioplasty with bad cosmetic
results. This was the reason while in this two children we have
used the techniques described by KAZUHIKO et al. in 1985 with
satisfactory results.
As reported by KAZUHIKO et al. all the
advantages of the use of the inner table are the following: no
additional skin incisions are necessary, nor is the need for bone
to be taken from other parts of the body: phyiological fusion can
be expected; foreign body reaction avoided. This technique had some
disadvantages, however: it is difficult in large sized bone defect,
and in elderly patients, here splitting the two tables of the skull
may be difficult because of the sclerotic changes in the skull.
In conclusion, we agree with KAZUHIKO et all
that this method provides intraoperative one-stage craniopIasty
using autogenous bone taken from the same operative field. This
method of grafting can be used in various situations, but is
particularly useful in young patients and in Africa where the
acrilic material may not be available.
References
1. KAZUHIKO K., HIROHIKO G. SHIGEAKI K,
KENICHIRO S. (1985) Cranioplasty with inner table of bone flap.
Technical note. J. Neurosurg 62:607-609.
2. RUBERTI R (1956) Cranioplastica rapida
con resina acrilica secondo la technica di Woringer.Chirurgia
11:156-157.
3. WORINGER E, SCHWIEG B.,BROGLY G.,SCHNIEDER J. ( 1951 )
Nouvelle technique ultra-rapide pour la refection des breches
osseusescraniennes a la resine acrilique. Revue Neurol. 85:43 5-43
8.
Copyright 1995 Pan African Association of Neurological
Sciences
|