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Iatrogenic cranial bone defects can result after craniotomies for trauma or infection,
with subsequent loss of bone flap after craniotomy. However, defects may also occur
if proper care is not taken for fixation of the bone flap that has been elevated for
exposure of the deeper structure in the cranial cavity. Recently, we came across a
woman who was referred for a contour defect after surgery for intracranial aneurysm.
The woman had undergone right pterion craniotomy for clipping of right anterior communicating
artery aneurysm 8 months previously. She presented with a slit-like deformity over
the forehead, running almost vertically over the centre of the right eyebrow. A palpable
2-cm-wide gap was seen between the edges of the bone. The two bony margins were at
different levels, leading to a contour deformity (Fig. 1). Computed tomography scan with three-dimensional reconstruction showed that the
pterion bone flap had migrated posteroinferiorly, leading to a defect in the region
of the forehead due to the over-riding of the bone edges posteriorly (Fig. 2). This was corrected by approaching the defect through a coronal incision. The bone
flap that had mal-united inferiorly was re-fractured and moved antero-superiorly.
This left a bone defect in the posteroinferior part, and was corrected by using strips
of split cranial bone graft taken from the adjacent area. Miniplates and screws were
used to fix the bone flap and bone grafts. Appearance 3 months after surgery is shown
in Fig. 3.
Figure 1Cranial bone defect in the fronto-temporo-parietal area.
