Heterotopic ossification following suboccipital craniectomy decompression surgery for Chiari malformation type I: case report

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Suboccipital craniectomy with duraplasty is a commonly performed procedure for children with symptomatic Chiari malformation type I (CM-I). Several dural substitutes are used for duraplasty, ranging from pericranium to synthetic materials. When available, autologous pericranium is often preferred due to its low cost, performance in obtaining a watertight closure, ease of suturing, and absence of immune reaction. Long-term follow-up data on the durability of various dural substitutes are lacking. The authors report a rare, long-term complication of duraplasty performed using an autologous pericranial graft, and they conduct a literature review of similar complications. Heterotopic ossification of an autologous pericranial graft is a rare complication of duraplasty. This dystrophic bone growth can be symptomatic due to compression of neural structures, and it requires reoperation for removal. Surgeons should consider this rare long-term complication in patients presenting with unusual symptoms after duraplasty with pericranium.

ABBREVIATIONS CM-I = Chiari malformation type I; HO = heterotopic ossification.

Article Information

Correspondence David F. Bauer: Dartmouth-Hitchcock Medical Center, Lebanon, NH. david.f.bauer@hitchcock.org.

INCLUDE WHEN CITING Published online March 29, 2019; DOI: 10.3171/2019.1.PEDS18680.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative flexion-extension radiographs demonstrating dystrophic bone fragment (arrows) 4 years after CM-I decompression and duraplasty.

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    Preoperative flexion-extension CT scans showing mobile dystrophic bone fragment 4 years following CM-I decompression and duraplasty (arrows). This finding was distinct from the results of CT scanning 3 years prior.

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    Preoperative MR image. Despite episodic neck pain and a clicking sound on neck extension, routine MRI was not concerning for spinal cord compression.

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    Intraoperative photographs showing resected dystrophic bone segments.

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    Postoperative MR image obtained after elective suboccipital decompression, removal of dystrophic ossification of the occipital bone, placement of a dural graft, removal of the arch of C1, and C2 laminectomy.

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