• Bik Liang Lau, Mohd Iryan Che Othman, Mohd Fakhri M D Fathil, Liew Donald Ngian San DNS Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Jalan Hospital, Kuching, Malaysia., Lim Swee San SS Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Jalan Hospital, Kuching, Malaysia., Mohamad Adam Bujang, and Wong Albert Sii Hieng ASH Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Jalan Hospital, Kuching, Malaysia..
• Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Jalan Hospital, Kuching, Malaysia. Electronic address: laubikliang@gmail.com.
• World Neurosurg. 2019 Jul 1; 127: e497-e502.

BackgroundReplacing the skull defect with synthetic materials for hyperostotic bone secondary to meningioma is recommended owing to the possibility of tumor invasion. In our institution, neurosurgeons have been putting back the refashioned hyperostotic bone flap after meningioma excision because of budget constraints. The aim of this study was to review the long-term meningioma recurrence rate in these patients.MethodsThis was a nonrandomized, prospective observational study conducted from September 2011 to January 2015 on patients with intracranial convexity and parasagittal meningiomas. Preoperative computed tomography brain scans were obtained in all patients to confirm bony hyperostosis. Intraoperatively, part of the hyperostotic bone was sent for histopathologic examination. The rest of the bone flap was refashioned by drilling off the hyperostotic part. The bone flap was put back over the craniotomy site after soaking in distilled water. All patients were followed up for tumor recurrence.ResultsThe study included 34 patients with convexity or parasagittal meningioma World Health Organization grade I-II who underwent Simpson grade Ia and IIa excision. Median follow-up was 63.5 months (mean 64.9 ± 9.4 months). The hyperostotic bone flap showed presence of tumor in 35% of patients. There were 2 patients with parasagittal meningiomas after Simpson grade IIa resections who developed tumor recurrences.ConclusionsOur study found that meningioma recurrence was unlikely when autologous cranioplasty was done with refashioned hyperostotic bone. This could be done in the same setting with meningioma excision. There was no recurrence in convexity meningiomas at mean 5-year follow-up.Copyright © 2019 Elsevier Inc. All rights reserved.

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