Short reports and Correspondence| Volume 60, ISSUE 12, P1356-1357, December 2007

Cranial defect after sliding of bone flap: A preventable complication

Published:September 03, 2007DOI:
      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 thumbnail gr1
      Figure 1Cranial bone defect in the fronto-temporo-parietal area.
      Figure thumbnail gr2
      Figure 2Computed tomography scan showing displaced bone flap with over-riding in the temporal region.
      Figure thumbnail gr3
      Figure 3Appearance 3 months after correction of the deformity.
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