Acta Neurochirurgica

, Volume 161, Issue 3, pp 483–491 | Cite as

Bone resorption in autologous cryopreserved cranioplasty: quantitative evaluation, semiquantitative score and clinical significance

  • Lina Raffaella BarzaghiEmail author
  • Veronica Parisi
  • Carmen Rosaria Gigliotti
  • Lodoviga Giudice
  • Silvia Snider
  • Antonio Dell’Acqua
  • Antonella del Vecchio
  • Pietro Mortini
Original Article - Neurosurgery general
Part of the following topical collections:
  1. Neurosurgery general



Changes after reimplantation of the autologous bone have been largely described. However, the rate and the extent of resorption in cranial grafts have not been clearly defined. Aim of our study is to evaluate the bone flap resorption (BFR) after cryopreservation.


We retrospectively reviewed 27 patients, aged 18 years or older, subjected to cranioplasty (CP) adopting autologous cryopreserved flap. The BFR was derived from the percentage of decrease in flap volume (BFR%), comparing the first post-operative computed tomography (CT) and the last one available (performed at least 1 year after surgery). We also proposed a semiquantitative scoring system, based on CT, to define a clinically workable BFR classification.


After a mean ± SE follow-up of 32.5 ± 2.4 months, the bone flap volume decreased significantly (p < 0.0001). The mean BFR% was 31.7 ± 3.8% and correlated with CT-score (p < 0.001). Three BFR classes were described: mild (14.8% of cases) consisting in minimal bone remodelling, CT-score ≤ 6, mean BFR% = 3.5 ± 0.7%; moderate (51.9% of cases) corresponding to satisfactory cerebral protection, CT-score < 13, mean BFR% = 25.6 ± 2.2%; severe (33.3% of cases) consisting in loss of cerebral protection, CT-score ≥ 13, mean BFR% = 54.2 ± 3.9%. Females had higher BFR% than males (p = 0.022). BFR classes and new reconstructive surgery were not related (p = 0.58).


BFR was moderate or severe in 85.2% of re-implanted cryopreserved flaps. The proposed CT-score is an easy and reproducible tool to define resorption extent.


Autologous bone cranioplasty Aseptic bone flap resorption Cryopreservation Radiological evaluation 



Bone flap resorption


Percentage of decrease in flap volume




Computed tomography


Extended–Glasgow Outcome Scale



Authors are grateful to Mrs. Francesca Villa, nurse of the Neurocritical Care Unit, for her support in all steps of the cranial bone storage and reimplantation.

Compliance with ethical standards

All procedures were performed in accordance with the World Medical Association Declaration of Helsinki and no submission to institutional ethical committee was required. Written informed consent was obtained by the patient itself or, in case of subjects unable to provide it, by next of kin.

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

701_2018_3789_MOESM1_ESM.docx (106 kb)
ESM 1 (DOCX 106 kb)
701_2018_3789_MOESM2_ESM.docx (37 kb)
ESM 2 (DOCX 36 kb)


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Lina Raffaella Barzaghi
    • 1
    Email author
  • Veronica Parisi
    • 1
  • Carmen Rosaria Gigliotti
    • 2
  • Lodoviga Giudice
    • 1
  • Silvia Snider
    • 1
  • Antonio Dell’Acqua
    • 3
  • Antonella del Vecchio
    • 2
  • Pietro Mortini
    • 1
  1. 1.Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific InstituteVita-Salute UniversityMilanItaly
  2. 2.Department of Medical Physics, IRCCS San Raffaele Scientific InstituteVita-Salute UniversityMilanItaly
  3. 3.Department of Neurocritical Care, IRCCS San Raffaele Scientific InstituteVita-Salute UniversityMilanItaly

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