{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:47:15Z","timestamp":1782283635295,"version":"3.54.5"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Autologous cranioplasty remains the first-line option for skull defect repair after decompressive craniectomy, with well-documented advantages of excellent biocompatibility, no immune reaction, and favorable cosmetic outcomes. Autologous skull graft resorption (ASGR) is a common postoperative complication that may lead to recurrent defects, poor cosmesis, and even neurological compromise. Patients with prior ventriculoperitoneal (VP) shunt are at substantially higher risk, yet long-term follow-up data and optimal management strategies in this subgroup remain poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case description<\/jats:title>\n                    <jats:p>A 27-year-old male presented with spontaneous intracerebral hemorrhage secondary to cerebral arteriovenous malformation. He underwent emergency hematoma evacuation, AVM resection, decompressive craniectomy, and ePTFE duraplasty. Postoperatively, VP shunt was placed for communicating hydrocephalus. Autologous cranioplasty was performed two months later. Serial cranial CT follow-up revealed progressive ASGR starting at six months, with marked regional predominance in the occipital stress-bearing area. One year postoperatively, shunt pressure was adjusted upward for decompression window depression. The patient remained asymptomatic throughout a 3-year follow-up without revision cranioplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ASGR in VP-shunted patients is driven primarily by chronic intracranial hypotension. This case demonstrates that long-term conservative surveillance with individualized shunt pressure titration is safe and effective for asymptomatic moderate-to-severe ASGR, and that timely pressure adjustment may significantly slow resorption progression. Regional mechanical stress further exacerbates resorption. Routine imaging and close intracranial pressure monitoring are essential for high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1838348","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:55:36Z","timestamp":1782280536000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Autologous skull graft resorption following cranioplasty: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Miao","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Sichuan Mianyang 404 Hospital\u00b7Affiliated Hospital of Southwest University of Science and Technology","place":["Mianyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huarong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jiange County People\u2019s Hospital","place":["Guangyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yurong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Mianyang Hospital Affiliated to University of Electronic Science and Technology\u00b7Mianyang Central Hospital","place":["Mianyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e70027","DOI":"10.1002\/mco2.70027","article-title":"Cerebral vascular malformations: pathogenesis and therapy","volume":"5","author":"He","year":"2024","journal-title":"Med Comm"},{"key":"B2","doi-asserted-by":"publisher","first-page":"935171","DOI":"10.3389\/fsurg.2022.935171","article-title":"Improved strategy for post-traumatic hydrocephalus following decompressive craniectomy: experience of a single center","volume":"9","author":"Wang","year":"2023","journal-title":"Front Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"600","DOI":"10.5137\/1019-5149.JTN.44249-23.2","article-title":"Factors affecting resorption after autologous cranioplasty","volume":"34","author":"Yuruk","year":"2024","journal-title":"Turk Neurosurg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s00701-025-06480-0","article-title":"Autologous vs synthetic cranioplasty","volume":"167","author":"Snee","year":"2025","journal-title":"Acta Neurochir (Wien)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e21035","DOI":"10.1097\/MD.0000000000021035","article-title":"Risk factors for bone flap resorption after autologous bone cranioplasty: protocol for a systematic review and meta-analysis","volume":"99","author":"Yang","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1007\/s00701-024-06282-w","article-title":"Complications after autologous cranioplasty following decompressive craniectomy","volume":"166","author":"Ritter","year":"2024","journal-title":"Acta Neurochir (Wien)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e853","DOI":"10.1016\/j.wneu.2017.10.112","article-title":"Cryopreservation of autologous cranial bone flaps for cranioplasty: a large sample retrospective study","volume":"109","author":"Fan","year":"2018","journal-title":"World Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1915","DOI":"10.1007\/s10143-022-01737-z","article-title":"A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy","volume":"45","author":"Signorelli","year":"2022","journal-title":"Neurosurg Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.3171\/2017.6.JNS17943","article-title":"Subcutaneous bone flap storage after emergency craniectomy: cost-effectiveness and rate of resorption","volume":"129","author":"Ernst","year":"2018","journal-title":"J Neurosurg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1007\/s00701-024-06312-7","article-title":"The role of autologous bone in cranioplasty. 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