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Combined Autogenous and Alloplastic Cranioplasty in a 15-Year-Old Trauma Patient - a Case Report

Roksana Tsvetanova, Zhenya Marinova, Tsvetan Popov, Yavor Enchev, Bogomil Iliev

Abstract

Introduction: The skull integrity is of utmost importance for the permanent brain protection. Posttraumatic skull defects are disfiguring and potentially hazardous for the underlying brain especially when they are extensive and when they are in children. Cranioplasty represents a classical surgical procedure to repair large skull defects. Nowadays, cranioplasty remains a challenging surgical intervention even for experienced neurosurgeons, particularly when concerning the reconstruction of spacious skull defects in the cosmetically important frontotemporal regions of the child skull.

Materials and Methods: We present a 15-year-old female patient with a bone fracture оf the skull caused by direct trauma due to a traffic accident. CT examination of the head showed polyfragmented fracture in the right frontotemporal region with underlying brain contusion. Craniotomy and extirpation of the impressed bone fragments were performed. Autogenous and alloplastic cranioplasty materials were used for total reconstruction of the skull defect. The patient was followed-up clinically and radiologically. Glasgow Outcome Scale (GOS) scores were assessed for 3 months postoperatively.

Results: The duration of the cranial reconstruction procedure was 4 hours. Clinically in the postoperative period the patient didn’t develop any neurological deficits and the postoperative CT examination demonstrated excellent cosmetic effect. The patient received antibiotic prophylaxis up to 5 days after surgery. GOS result was 5 at the 3-month follow-up.

Conclusion: The data suggests that the combined аutogenous and аlloplastic сranioplasty is a safe and effective treatment option for polyfragmented skull fractures in children. The total cranial reconstruction in children must always consider the eventual forthcoming growth of the skull.


Keywords

children, traumatic injury, skull fracture, autologous and alloplastic, cranioplasty


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