Autologous Bone Flap Cranioplasty—Outcomes of in Terms of Cosmetic and Function

Decompressive craniotomy (DC) is defined as the removal of a large area of skull with opening of dura to increase the volume of cranial cavity, facilitating a reduction in intracranial pressure. DC is a surgical option in the management of refractory intracranial hypertension when maximal medical treatment has failed to control it, especially in head injury, stroke, and postoperative edema after brain surgery. Autologous bone flap cranioplasty outcomes of in terms of cosmetic and function. A prospective and retrospective study from 2019 to 2023 of patients who presented to the Department of Neurosurgery NSCB Medical College, Jabalpur with previous history of craniotomy with bone in anterior abdominal wall and underwent cranioplasty in 1 year from the date of approval from the ethical committee were included in the study. This study was defined as early cranioplasty when the time interval between craniectomy and cranioplasty performed was within 3 months and late cranioplasty when cranioplasty waited for more than 3 months. Majority of the patients were in the age group 21 to 40 years. The mean age of the patients was 32.32 ± 10.68 years (range: 9 to 61 years). There were 14 (15.9%) females and 74 (84.1%) males. The male:female ratio was 5.3:1. Operated case of traumatic brain injury was seen in 86 (97.7%) patients, basal ganglia bleed in 1 (1.1%) patient, and arrow injury in 1 (1.1%) patient. Majority of the patients had an interval of more than or equal 12 weeks between craniectomy and cranioplasty. Complications are not affected by interval between craniectomy and cranioplasty. The difference was found to be statistically not significant (p = 0.532), showing a comparable mean hospital stay between the two intervals. Mortality was not seen in any of the patients. All the patients were discharged from the hospital. At 3 months follow-up, none of the patients experienced any adverse events or expired in both the interval groups. Cranioplasty ensures cosmesis and protection of underlying brain and may even improve postoperative neurological status. Reinsertion of the previously harvested autologous bone flap is the method of choice for most institution because of its low cost and excellent anatomical fit. Out of 88 patients 84 achieved satisfactory cosmetic reconstruction, while 4 cases required augmentation with titanium mesh to achieve cosmetic needs. Our study was for short term and in this study, we had limited amount of relevant data and time. Based on reviews of studies for standardization of better cranioplasty long studies and more material are required. There is hence need for future studies on how to reduce complications to improve clinical outcomes.