Reconstruction of suboccipital craniectomy with autologous bone chips

Effective restoration of the previous function and shape of any muscle-skeletal iatrogenic defects is one of the last but not least purposes of neurosurgical practice. In suboccipital approaches the best cosmetic and functional results are obtained by repositioning the bone flap resulting from osteoplastic trepanation. In fact, the burr-holes and any small or large craniectomy should be filled in at the end of operation to avoid not only undesiderable cosmetic results but also postoperative headache. A variety of techniques have been successfully employed to reconstruct craniectomy and/or craniotomy bone gaps such as bone grafts, silastic, acrylic or metal plates, hydroxyapatite cement or ceramic implants. On the other hand, it has been demonstrated that cranioplasty using a mixture of autologous bone chips and allogenic fibrin glue restores the bone plate following craniectomies. Since fibrin glue is unavailable in some countries due to religious beliefs, national restrictions, limited stocks or production, we conducted a study in which the bone chips were re-positioned intraoperatively without the aid of fibrin glue to assess the value of autogenous bone chips in craniectomy patients. In the majority of cases in which an osteoplastic suboccipital craniotomy is not possible, repositioning of the bone chips from suboccipital craniectomy is able to restore a bone table, thus allowing morphological and functional recovery of the occipital region.