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  • Title: [Repair of osteomeningeal loss of substance of the skull in infants. A personal technic used in dehiscent fractures and neonatal craniectomies].
    Author: Czorny A, Roche JL.
    Journal: Neurochirurgie; 1988; 34(5):323-7. PubMed ID: 3231292.
    Abstract:
    In infants, two types of pathologies require treatment for osteomeningeal substance losses of the cranial vault: --posttraumatic skull fracture dehiscence, --decompressive craniectomy for neonatal intracranial hematomas. Osseous dehiscence alone does not explain the pathogenesis of the condition, and treatment must take subjacent lesions into account. The progressive nature of these lesions is linked to the considerable brain growth that reaches its maximum during the first year of life. Pressure is also exerted by contingent phenomena: the edema caused by the subjacent brain contusion and hydrocephalus. Treatment principles include: --insertion of a normal vault, with its two tables, opposite a sutured meninges or a membrane that has been replaced by a more or less pedunculated pericranial autoplasty, --creation of contact between the bone defect and healthy dura mater that has conserved its outer osteogenic layer and, if possible, a healthy pedunculated pericranium. The authors propose 180 degrees flap rotations for extensive losses of substance and 90 degrees rotations after synthesis of a fracture. In cases of a frontal lesion or extensive craniectomy, flap exchange procedures are recommended; periosteal flaps are used for covering purposes, respecting the principles above for the donor sites. These techniques have been used for three cases of traumatic osteo-dural tears and 3 craniectomies; short term and especially long term results are satisfactory.
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