title: Free craniotomy versus osteoplastic craniotomy, assessment of flap viability using 99mTC MDP SPECT.
abstract: There are currently two accepted neurosurgical methods to perform a bony flap. In an osteoplastic flap, the flap is attached to surrounding muscle. In a free flap, the flap is not attached to adjacent tissues. The former is less common due to its complexity and the extensive time required for the surgery; yet the rate of infection is significantly lower, a clear explanation for which is unknown. The objective of this study was to test the hypothesis that the osteoplastic flap acts as a live implant that resumes its blood flow and metabolic activity; contrasting with the free flap, which does not have sufficient blood flow, and therefore acts as a foreign body. Seven patients who underwent craniotomy with osteoplastic flaps and five with free flaps had planar bone and single photon emission computed tomography (SPECT) scans of the skull at 3-7days postoperative, after injection of the radioisotope, 99m-technetium-methylene diphosphonate (99m-Tc-MDP). We compared radioactive uptake as a measure of metabolic activity between osteoplastic and free flaps. Mean normalized radioactive uptakes in the centers of the flaps, calculated as the ratios of uptakes in the flap centers to uptakes in normal contralateral bone, were [mean: 1.7 (SD: 0.8)] and [0.6 (0.1)] for the osteoplastic and free flap groups respectively and were [2.4 (0.8)] and [1.3 (0.4)] in the borders of the flaps. Our analyses suggest that in craniotomy, the use of an osteoplastic flap, in contrast to free flap, retains bone viability.
authors.affiliation: Diagnostic Imaging Department, Soroka University Medical Center, POB-151, Beer Sheva 84101, Israel. Electronic address: shelef@bgu.ac.il.
authors.forename: Ilan
authors.initials: I
authors.lastname: Shelef
authors.affiliation: Nuclear Medicine, Assaf Harofe Medical Center, Zerifin, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Golan
authors.affiliation: Neurosurgical Oncology Unit, Department of Neurosurgery, Soroka University Medical Center, Beer Sheva, Israel; Minimally Invasive Neurosurgery Unit, Department of Neurosurgery, Soroka University Medical Center, Beer Sheva, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Merkin
authors.affiliation: Neurosurgical Oncology Unit, Department of Neurosurgery, Soroka University Medical Center, Beer Sheva, Israel; Minimally Invasive Neurosurgery Unit, Department of Neurosurgery, Soroka University Medical Center, Beer Sheva, Israel.
authors.forename: Israel
authors.initials: I
authors.lastname: Melamed
authors.affiliation: Pediatric Neurosurgery Unit, Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Mony
authors.initials: M
authors.lastname: Benifla
mesh_terms: D000368:Aged; D001842:Bone and Bones / Q000378:metabolism / Q000502:physiology; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012039:Regional Blood Flow; D012886:Skull / Q000000981:diagnostic imaging; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000453:epidemiology; D013669:Technetium Tc 99m Medronate; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013669:Technetium Tc 99m Medronate
keywords: Craniotomy; Flap viability; Neurosurgery; Nuclear medicine; Osteoplastic flap