Bone flap resorption after complications of in elective neurosurgery (case study)

Сraniotomy is an integral part of modern elective neurosurgery which involves cutting a free bone flap to provide access to pathological intracranial structures with its reimplantation at the end of surgery. Bone flap grafting in the trepanation window with various fixation methods in the end of elective neurosurgery in the absence of severe cerebral edema or cancer-induced bone destruction is a standard procedure that restores the skull shape, cerebrospinal fluid dynamics and cerebral perfusion. According to the literature, the incidence of aseptic inflammation with subsequent resorption of the bone flap after craniotomy in elective neurosurgery is not clearly defined. An analysis of medical publications in the PUBMED database showed few reports of bone flap resorption after elective craniotomy, and no reports were found after the search in the eLibrary database. Thus, the number of reports on the bone flap resorption after craniotomy in elective neurosurgery is limited, and the pathophysiology of this process remains unclear. However, the described complication of craniotomy can lead to the dislocation of a bone flap, the development of a local pain syndrome, a cosmetic defect, and disturbances in cerebrospinal fluid dynamics. The article describes an example of partial resorption of a bone flap after craniotomy for the removal of meningioma in the middle third of the superior sagittal sinus, which required a number of repeated neurosurgical interventions. The treatment was finished with the removal of a partially resorbed bone flap and implantation of an individual titanium mesh implant.