Autologous Calvarial Bone Remodeling Technique for Small to Medium-Sized Cranial Defects in Young Children: The “Switch-Cranioplasty” Technique

<b><i>Introduction:</i></b> Reconstruction of cranial defects in children less than 2 years of age, particularly when there is an associated dural defect, is challenging due to the need to accommodate active skull growth, limited options for autologous bone graft and thin calvarial bones. We use a simple remodeling technique that exploits the normal dura’s inherent potential for new bone growth while covering the dural defect with adjacent skull. <b><i>Case Presentation:</i></b> We describe an alternating, two-piece craniotomy or “switch-cranioplasty technique” to repair an occipital meningocele. The two pieces of craniotomy bone flap created around the existing skull and dural defect are switched in the horizontal plane in order to cover the site of the defect and the abnormal dura of the meningocele closure. The area of the original skull defect is transposed laterally over the normal dura. The healing of the lateral skull defects is facilitated with autologous bone chips and dust and covered by periosteal flaps that stimulate spontaneous re-ossification. <b><i>Discussion:</i></b> The advantages of this technique are the use of autologous bone adjacent to the skull defect, incorporation of the autologous bone into the growing skull, an acceptable cosmetic and functional outcome in a simple manner. The indications can be extended to include small to medium-sized calvarial defects secondary to leptomeningeal cyst and trauma.

Leptomeningeal Cyst in the Adult: Case Report and Review of the Literature

Background: Leptomeningeal cysts are a rare complication of childhood fractures, being very rare in adulthood and usually related to previous trauma generated in children. Case Presentation: We present a case of “growing fracture” in a 70-year-old woman with a history of head injury in childhood, who clinically debuted with paresthesia-dysesthesia in the left hemicranium and hypersensitivity and pain in the affected area, and who was treated with surgical treatment. Conclusion: We review the pathogenesis, diagnosis and treatment of this injury today.