Abstract :
The degree of meningioma resection is regarded as the most significant factor in the rate of recurrence and correlates directly with clinical longterm outcome. The radicality of excision may be hampered by bone involvement. Objective: To evaluate feasibility and outcome of repositioning the patients autoclaved bone flap, in convexity meningiomas with bone affection, as an alternative cranioplasty technique. Methods: The patient’s own bone flap served as a cranioplasty material after being autoclaved intra-operatively for potential bone invasion. Clinical and radiological follow-up, to assess occurrence of infection, bone resorption, cosmesis and tumor recurrence. Results: Nine women and three men (mean age 52.2 years ± 6.7, range 42 – 65 years) underwent gross total tumor resection of meningiomas invading the skull, for which their bone flaps (mean area of flap 54.2 cm^2 ± 27, range 20 – 120 cm^2) were autoclaved. Radiological and clinical follow-up examinations revealed that, none of the cases had post operative infection, flap sequestration, or extrusion. There was excellent implant alignment, with minimal or no bone resorption and favorable cosmesis (visual analogue scale for cosmesis [VASC] 90 ± 9, range 70-100) in all patients. No Signs of recurrences were detected till the end of the follow up duration (mean follow up duration of the cases was 35.5 months ± 10.4, range 18 – 52 months). Conclusions: Intraoperative in situ cranioplasty with autogenous autoclaved bone flap provides excellent bony alignment, and a favorable cosmetic outcome. Reduces the costs and operation time. It is an adequate means of addressing potential areas of bone invasion which would be responsible for possible tumor recurrences.
