{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T03:43:11Z","timestamp":1786592591044,"version":"build-2736575974"},"reference-count":13,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Decompressive craniectomy with subsequent autologous cranioplasty, or the replacement of the native bone flap, is often used for pediatric patients with traumatic brain injury (TBI) who have a mass lesion and intractable intracranial hypertension. Bone flap resorption is common after bone flap replacement, necessitating additional surgery. The authors reviewed their large database of pediatric patients with TBI who underwent decompressive craniectomy followed by bone flap replacement to determine the rate of bone flap resorption and identify associated risk factors.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective cohort chart review was performed to identify long-term survivors who underwent decompressive craniectomy for severe TBI with bone flap replacement from January 1, 1996, to December 31, 2011. The risk factors investigated in a univariate statistical analysis were age, sex, underlying parenchymal contusion, Glasgow Coma Scale score on arrival, comminuted skull fracture, posttraumatic hydrocephalus, bone flap wound infection, and freezer time (the amount of time the bone flap was stored in the freezer before replacement). A multivariate logistic regression model was then used to determine which of these were independent risk factors for bone flap resorption.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Bone flap replacement was performed at an average of 2.1 months after decompressive craniectomy. Of the 54 patients identified (35 boys, 19 girls; mean age 6.2 years), 27 (50.0%) experienced bone flap resorption after an average of 4.8 months. Underlying parenchymal contusion, comminuted skull fracture, age \u2264 2.5 years, and posttraumatic hydrocephalus were significant, or nearly significant, on univariate analysis. Multivariate analysis identified underlying contusion (p = 0.004, OR 34.4, 95% CI 3.0\u2013392.7), comminuted skull fractures (p = 0.046, OR 8.5, 95% CI 1.0\u201369.6), posttraumatic hydrocephalus (p = 0.005, OR 35.9, 95% CI 2.9\u2013436.6), and age \u2264 2.5 years old (p = 0.01, OR 23.1, 95% CI 2.1\u2013257.7) as independent risk factors for bone flap resorption.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>After decompressive craniectomy for pediatric TBI, half of the patients (50%) who underwent bone flap replacement experienced resorption. Multivariate analysis indicated young age (\u2264 2.5 years), hydrocephalus, underlying contusion as opposed to a hemispheric acute subdural hematoma, and a comminuted skull fracture were all independent risk factors for bone flap resorption. Freezer time was not found to be associated with bone flap resorption.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.1.peds12483","type":"journal-article","created":{"date-parts":[[2013,3,8]],"date-time":"2013-03-08T15:04:47Z","timestamp":1362755087000},"page":"526-532","source":"Crossref","is-referenced-by-count":143,"title":["Risk factors and rates of bone flap resorption in pediatric patients after decompressive craniectomy for traumatic brain injury"],"prefix":"10.3171","volume":"11","author":[{"given":"Christian A.","family":"Bowers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Riva-Cambrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean A.","family":"Hertzler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion L.","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds12483","series-title":"Arch Pediatr Adolesc Med","first-page":"641","article-title":"Variation in intracranial pressure monitoring and outcomes in pediatric traumatic brain injury","volume":"166","author":"Bennett","year":"2012"},{"key":"b2-peds12483","series-title":"ANZ J Surg","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/j.1445-2197.2010.05584.x","article-title":"Bone flap storage following craniectomy: a survey of practices in major Australian neurosurgical centres","volume":"81","author":"Bhaskar","year":"2011"},{"key":"b3-peds12483","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1097\/01.PRS.0000079860.14734.D6","article-title":"Mechanical strain affects dura mater biological processes: implications for immature calvarial healing","volume":"112","author":"Fong","year":"2003"},{"key":"b4-peds12483","series-title":"Birth Defects Res C Embryo Today","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1002\/bdrc.20104","article-title":"Cellular dynamics and tissue interactions of the dura mater during head development","volume":"81","author":"Gagan","year":"2007"},{"issue":"2 Suppl Pediatrics","key":"b5-peds12483","series-title":"J Neurosurg","first-page":"163","article-title":"Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents","volume":"100","author":"Grant","year":"2004"},{"key":"b6-peds12483","series-title":"Z Kinderchir","first-page":"375","article-title":"The prognosis of cranioplasty following large craniectomy in children","volume":"43","author":"Gruber","year":"1988"},{"key":"b7-peds12483","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1227\/01.NEU.0000047891.86938.46","article-title":"The use of frozen autogenous bone flaps in delayed cranioplasty revisited","volume":"52","author":"Iwama","year":"2003"},{"issue":"5 Suppl","key":"b8-peds12483","series-title":"J Neurosurg","first-page":"337","article-title":"Outcomes after decompressive craniectomy for severe traumatic brain injury in children","volume":"105","author":"Kan","year":"2006"},{"key":"b9-peds12483","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1227\/01.NEU.0000186013.63046.6B","article-title":"Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors","volume":"57","author":"Maas","year":"2005"},{"key":"b10-peds12483","series-title":"J Trauma","first-page":"133","article-title":"Decompressive craniectomy in 14 children with severe head injury: clinical results with long-term follow-up and review of the literature","volume":"71","author":"P\u00e9rez Su\u00e1rez","year":"2011"},{"key":"b11-peds12483","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"268","DOI":"10.3171\/2012.6.PEDS1268","article-title":"Optimal timing of autologous cranioplasty after decompressive craniectomy in children. Clinical article","volume":"10","author":"Piedra","year":"2012"},{"key":"b12-peds12483","series-title":"Eur J Pediatr Surg","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1055\/s-2008-1042487","article-title":"Cranioplasty for acquired skull defects in children\u2014a comparison between autologous material and methylmethacrylate 1974\u20131990","volume":"1","author":"Pochon","year":"1991"},{"issue":"6","key":"b13-peds12483","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E7","DOI":"10.3171\/2009.4.FOCUS0965","article-title":"Complications of decompressive craniectomy for traumatic brain injury","volume":"26","author":"Stiver","year":"2009"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/11\/5\/article-p526.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/11\/5\/article-p526.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/11\/5\/article-p526.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T14:22:20Z","timestamp":1681568540000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/11\/5\/article-p526.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2013,5]]},"references-count":13,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2013.1.peds12483","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,5]]}}}