Abstract:

BACKGROUND: Cranial defects need decompressive craniectomy owing to severe craniocerebral injury or spontaneous cerebral hemorrhage. Cranioplasty is generally necessary at 3-9 months after first surgery. Autologous cranial bone, as an ideal repair material, has aroused wide attention from neurosurgeons. 
OBJECTIVE: After 3-9 months of subperitoneal embedding, autologous cranial valves with periosteum were taken out for repair of cranial bone defects. Cranial valves were observed in terms of size and shape as well as periosteal changes.
METHODS: In totally 100 severe cranial injury patients presenting with severe cerebral hemorrhage, brain herniation and high intracranial pressure after hematoma removal needed decompressive craniectomy and were included in this study. Craniotomy was performed with intact periosteum left. The mid/upper left quadrant abdominal skin was dissected to expose the superficial fascia. The convex surface of cranial valve was made close to the subcutaneous fat, followed by incision suture. Autologous cranial valves with periosteum were taken out after 3-9 months. Prior to and after preservation, the length, width, thickness, and diagonal length of cranial valves with periosteum were measured.
RESULTS AND CONCLUSION: 6-year clinical observation revealed that 72 cases of cranial valves were preserved for 3-4 months, showing sharp valve edge, without absorption or shrank cranial valve, bright red, soft, slightly thickened periosteum; 1 case of cranial valve was preserved for 9 months, showing blunt valve edge, obvious absorption, markedly reduced valve, light-colored periosteum, obvious osseous hyperplasia; the cranial valves of other cases showed phenomena between these two. These findings demonstrate that subperitoneal preservation of autologous cranial valve with periosteum can maintain the size, shape, and activity of cranial bone.