Scanning electron microscopic surface analysis of cryoconserved skull bone after decompressive craniectomy
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ORIGINAL PAPER
Scanning electron microscopic surface analysis of cryoconserved skull bone after decompressive craniectomy Thomas Beez • Martin Sabel • Sebastian Alexander Ahmadi Kerim Beseoglu • Hans-Jakob Steiger • Michael Sabel
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Received: 5 December 2012 / Accepted: 3 May 2013 / Published online: 15 May 2013 Ó Springer Science+Business Media Dordrecht 2013
Abstract Bone flaps removed during decompressive craniectomy are commonly frozen at -80 °C and stored until cranioplasty. Histological integrity and regenerative capacity have been shown for cryoconserved bone. The effects of cryoconservation on the surface structure are unknown, although these might cause mechanical instability or facilitate bacterial adhesion. This study evaluates the surface structure of cryoconserved bone by scanning electron microscopy. Five patients were identified who could not receive their autologous bone flaps after decompressive craniectomy. These redundant bone specimens were obtained after cryoconservation for 6–8 months and the outer surface was analyzed by scanning electron microscopy. We found varying surface structures which did not correlate with any variables, such as patient age, gender or duration of freezing, and probably reflect physiological interindividual variation. Pathological findings, such as microscopic crack formation, were not observed. Cryoconservation for up to 8 months does not appear to alter the surface
T. Beez (&) S. A. Ahmadi K. Beseoglu H.-J. Steiger M. Sabel Department of Neurosurgery, Heinrich-Heine-Universita¨t, Du¨sseldorf, Germany e-mail: [email protected] M. Sabel Federal Institute for Materials Research and Testing, Berlin, Germany
structure of skull bone on scanning electronic microscopy. Keywords Autologous skull bone Cranioplasty Cryoconservation Decompressive craniectomy Scanning electron microscopy
Introduction Decompressive craniectomy is an emergency procedure for the treatment of intractable elevated intracranial pressure. A large bone flap is removed to create additional space for the swollen brain and thus avoid cerebral herniation. Johnson et al. published a comprehensive summary of this surgical technique and its clinical application (Johnson et al. 2011). The bone flap is usually conserved and re-implanted once cerebral swelling has subsided. The optimal conservation technique of the bone flap, the timing of cranioplasty and the comparison of autologous bone and synthetic materials have been subject to various studies (Archavlis et al. 2012; Beauchamp et al. 2010; Chun and Yi 2011; Inamasu et al. 2010; Lee et al. 2012; Matsuno et al. 2006). However, clinical protocols differ widely at neurosurgical centers. At our institution, bone flaps are cryoconserved at -80 °C and re-implanted within 6 months following decompressive craniectomy. If cranioplasty is not possible within 6 months, synthetic implants are used. To our knowledge, the surface structure of skull bone or
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similar flat bones cryoconserved for prolonged periods has not been ex
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