de França Sabrina A, Nepomuceno Thales B, Paiva Wellingson S, Andrade Almir F, Teixeira Manoel J, Tavares Wagner M
IPSPAC - Instituto Paulista de Saúde para a Alta Complexidade. 6, Santo André, São Paulo, Brazil.
Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Surg Neurol Int. 2018 Mar 19;9:61. doi: 10.4103/sni.sni_388_17. eCollection 2018.
Craniectomies and cranioplasty are common neurosurgical procedures performed after brain trauma, ischemia, tumor resection, or infection. Post-cranioplasty autologous bone flap resorption may occur in patients after delayed cranial reconstruction. The occurrence is usually low when bone flaps are stored in subcutaneous abdominal tissue. We report a unique case of post-cranioplasty cranial bone flap.
We report a total autologous bone flap resorption in a 28-year-old man with a history of alcohol abuse. He was found unconscious in his bedroom with a head trauma of unknown mechanism. After an emergency room assessment, he was diagnosed with an acute subdural hematoma and underwent to emergency surgical drainage and a craniectomy. Three months later, a cranioplasty was performed and he exhibited exceptional outcomes. During a follow-up assessment, 7 months post-cranioplasty, total bone flap resorption was observed on computerized tomography image.
This case described an abnormal accelerated resorption of an autologous bone flap cranioplasty inserted after 3 months. Thus, to avoid bone flap resorption, an as early as possibly strategy may prevent this. Still, the exact mechanisms underlying bone resorption are poorly understood.
颅骨切除术和颅骨修补术是脑外伤、缺血、肿瘤切除或感染后常见的神经外科手术。延迟颅骨重建术后患者可能会出现颅骨修补术后自体骨瓣吸收。当骨瓣储存在腹部皮下组织时，发生率通常较低。我们报告了一例独特的颅骨修补术后颅骨骨瓣病例。
我们报告了一名有酗酒史的28岁男性出现完全自体骨瓣吸收的情况。他被发现昏迷在卧室，头部有不明原因的外伤。经过急诊室评估，他被诊断为急性硬膜下血肿，并接受了急诊手术引流和颅骨切除术。三个月后，进行了颅骨修补术，他的恢复情况良好。在颅骨修补术后7个月的随访评估中，计算机断层扫描图像上观察到骨瓣完全吸收。
本病例描述了3个月后植入的自体骨瓣颅骨修补术出现异常加速吸收的情况。因此，为避免骨瓣吸收，尽早采取策略可能会预防这种情况。然而，骨吸收的确切机制仍知之甚少。
