title: Novel technique for cranial reconstruction following retrosigmoid craniectomy using demineralized bone matrix.
abstract: OBJECTIVE
  A versatile neurosurgical approach, the retrosigmoid craniectomy (RS) has traditionally been associated with high rates of post-operative cerebrospinal fluid (CSF) leak, headaches, and aesthetic defects. We introduce a simple surgical strategy for bony cranial reconstruction designed to minimize peri-operative complications and improve cosmetic outcomes.
  
  
  METHODS
  In accordance with the Institutional Review Board, the senior author's (G.M.M.) records were queried between 2006 and 2014. We identified 50 consecutive patients who underwent demineralized bone matrix (DBM)-augmented cranioplasty after RS for MVD (DBM group) and 92 consecutive patients in whom standard cranial reconstruction was undertaken using autologous bone chips only after RS for MVD (non-DBM group). Demographic and clinical information regarding the laterality of each operation, intra-dural drilling for petrous hyperostosis, method of dural closure, length of hospitalization, presence of post-operative headaches, and procedure-related complications were collected and analyzed.
  
  
  RESULTS
  The DBM and non-DBM cohorts were well matched for age, laterality of procedure, surgical indications, primary versus revision surgery, intra-dural drilling of petrous hyperostosis, and dural closure techniques. Trigeminal neuralgia was the most common surgical indication (98.6%) in each cohort. Post-operatively, 15% of patients in non-DBM group experienced chronic headaches at the last follow-up compared to only 8% of the patients in the DBM group (p=0.21). The non-DBM patients also suffered more incisional pain in comparison to the DBM patients (7.6% vs. 0%, p=0.045).
  
  
  CONCLUSIONS
  DBM-augmented reconstruction of posterior fossa defects resulted in low rates of post-operative headaches, better cosmetic outcomes, and represents a simple and effective cranioplasty option for skull base surgeons.
authors.affiliation: Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI, USA. Electronic address: apabane1@hfhs.org.
authors.forename: Aqueel H
authors.initials: AH
authors.lastname: Pabaney
authors.affiliation: Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Reinard
authors.affiliation: Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Karam
authors.initials: K
authors.lastname: Asmaro
authors.affiliation: Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Ghaus M
authors.initials: GM
authors.lastname: Malik
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000627:therapeutic use; D001857:Bone Matrix / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials
keywords: CSF leak; Cranial defect; Cranioplasty; Demineralized bone matrix; Headaches; Microvascular decompression; Retrosigmoid craniectomy