ABSTRACT
Decompressive craniotomies with removal of the bone flap are still frequently performed in brain injured patients. Usually these bone flaps are refrigerated until reimplantation. In approximately 60% of cranioplasties performed in our clinic by this method we have observed considerable osteolysis especially in the marginal regions. This resulted in a instability which disturbed many patients and required an additional cranioplasty. Other methods for cranioplasty are briefly described. - For the last 3 years we have implanted the removed bone flaps immediately after craniotomy subcutaneously in the abdominal wall instead of preserving them in the refrigerator. By these means we were able to reimplant vital bone during the cranioplasty procedure weeks to months after the initial craniotomy. Our experience with this method shows a significant decrease of resorption in autologous cranioplasties. Out of 43 cases with a follow-up control after one and two years only 2 patients showed signs of resorption. One other bone flap was lost due to infection.
Subject(s)
Bone and Bones , Brain Injuries/surgery , Craniotomy/methods , Tissue Preservation/methods , Abdominal Muscles/surgery , Cerebral Hemorrhage/surgery , Humans , Replantation , Wound HealingABSTRACT
We are reporting on the necessity in CT follow-ups in neurotraumatized patients. According to our large number of patients with severe head trauma, the indication for repeated CT-scans has arrisen as follows: 1. In unconscious patients showing no improvement in their status within the first days and with a hemorrhagic contusion in their initial CT. 2. In neurotraumatized patients with multiple injuries which necessitate a respirator treatment with sedation and relaxation. The same applies for patients with primary severe brain edema which requires respirator treatment with sedation and relaxation to lower the intracranial pressure. 3. During the postoperative course in order to visualize the intracranial situation.
