Vanaclocha V, Sáiz-Sapena N, García-Casasola C, De Alava E
Department of Neurosurgery, University of Navarra, Pamplona, Spain.
Acta Neurochir (Wien). 1997;139(10):970-6. doi: 10.1007/BF01411307.
When a bone flap is raised in the course of a craniotomy, the ideal is to replace it at the end of the procedure. When it is invaded by tumoural cells, it cannot be replaced due to the risk of tumoural recurrence. In these cases we have autoclaved the bone flap to be able to replace it with no fear of tumoural recurrence. Between October 1989 and October 1995 sixty-two patients required autoclaving of the bone flap in the course of a craniotomy due to tumoural invasion (thirty-five meningiomas, sixteen bone tumours, five metastases, and eight scalp tumours). The infiltrated bone flaps were removed, cleaned, autoclaved for 20 minutes at 134 degrees C and 1 kg/cm2 and re-implanted. Patients were followed-up for 10 to 58 months (average 41 months). At every follow-up visit skull x-ray studies, clinical examination, and photographs were done. When needed a CT scan was performed to assess the thickness of the bone flap. On follow-up roentgenograms partial resorption was observed in twelve cases (19.3%). CT scan studies showed loss of thickness in another thirty-five cases (56.4%). Meanwhile the external aspect remained unchanged. In six cases (3.2%) biopsies of the bone flaps were taken at a second surgical procedure. They showed newly formed bone partly re-populated by osteocytes but retaining areas of sequestered bone. We conclude that autoclaved bone, if replaced with direct contact with living bone, it is gradually repopulated with osteocytes. Cranial vault autoclaved autologous bone flap is a good alternative when the original bone flap is invaded but not destroyed by tumoural cells.
在开颅手术过程中掀起骨瓣时，理想的做法是在手术结束时将其复位。当骨瓣被肿瘤细胞侵犯时，由于存在肿瘤复发的风险，不能将其复位。在这些情况下，我们对骨瓣进行了高压灭菌处理，以便能够将其复位而不必担心肿瘤复发。1989年10月至1995年10月期间，62例患者因肿瘤侵犯在开颅手术过程中需要对骨瓣进行高压灭菌处理（35例脑膜瘤、16例骨肿瘤、5例转移瘤和8例头皮肿瘤）。将受浸润的骨瓣取出、清理，在134℃和1kg/cm²条件下高压灭菌20分钟后重新植入。对患者进行了10至58个月的随访（平均41个月）。每次随访时都进行了颅骨X线检查、临床检查和拍照。必要时进行CT扫描以评估骨瓣的厚度。随访X线片显示12例（19.3%）有部分吸收。CT扫描研究显示另外35例（56.4%）骨瓣厚度减少。同时，外观保持不变。6例（3.2%）在第二次手术时对骨瓣进行了活检。活检显示有新形成的骨，部分被骨细胞重新填充，但仍保留有死骨区域。我们得出结论，如果将高压灭菌的骨与活骨直接接触复位，它会逐渐被骨细胞重新填充。当原始骨瓣被肿瘤细胞侵犯但未被破坏时，颅骨穹窿高压灭菌自体骨瓣是一种很好的替代方法。
