Ropper Alexander E, Rogers Gary F, Ridgway Emily B, Proctor Mark R
Department of Neurosurgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
J Neurosurg Pediatr. 2010 Nov;6(5):464-7. doi: 10.3171/2010.8.PEDS10140.
The authors report the case of a large idiopathic frontal bone defect and concomitant sagittal synostosis corrected by autologous exchange cranioplasty by using a corticocancellous bone graft and cranial vault expansion. An otherwise healthy, developmentally normal 6-year-old girl presented to our clinic with a large frontal bone defect. The osseous defect was midline and inferior to the coronal sutures, and the underlying dura was slightly tense. She had no signs or symptoms of increased intracranial pressure, and her head circumference and cephalic index were normal. Imaging demonstrated fusion of the sagittal synostosis. The defect was repaired using full-thickness autologous bone harvested from the bilateral parietal regions, which were widened using barrel-stave osteotomies to reduce pressure on the graft site in the setting of sagittal synostosis and mild cranial narrowing. The donor sites were covered with autologous particulate bone graft harvested from the endocortical surface of the grafted segments and the ectocortical surface of the intact parietal bones. The donor and recipient sites healed. Imaging revealed that the particulate bone healed with a thickness similar to the surrounding bone. This bony defect is analogous to parietal foramina and may have a similar etiopathogenesis. The technique of autologous exchange cranioplasty using corticocancellous particulate bone graft provides a simple and reliable method to repair large structural calvarial defects.
作者报告了一例大型特发性额骨缺损并伴有矢状缝早闭的病例，通过使用皮质松质骨移植和颅骨穹窿扩张进行自体置换颅骨成形术进行矫正。一名原本健康、发育正常的6岁女孩因大型额骨缺损前来我们诊所就诊。骨缺损位于中线且在冠状缝下方，其下方的硬脑膜略显紧张。她没有颅内压升高的体征或症状，头围和头指数均正常。影像学检查显示矢状缝早闭。使用从双侧顶叶区域获取的全层自体骨修复缺损，通过桶状骨切开术扩大双侧顶叶区域以减轻矢状缝早闭和轻度颅骨狭窄情况下移植部位的压力。供区用从移植段的皮质内表面和完整顶骨的皮质外表面获取的自体颗粒骨移植覆盖。供区和受区均愈合。影像学检查显示颗粒骨愈合后的厚度与周围骨相似。这种骨缺损类似于顶骨孔，可能具有相似的发病机制。使用皮质松质颗粒骨移植的自体置换颅骨成形术技术为修复大型颅骨结构缺损提供了一种简单可靠的方法。
