Bone Flap Resorption Associated with Indolent Propionibacterium acnes Infection After Cranioplasty: Case Report with Pathological Analysis

Nathan A. Shlobin, Aaron H. Palmer, Kwok Ling Kam, Daniel J. Brat, Matthew B. Potts*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Autologous bone resorption is a frequent complication of cranioplasty, often necessitating reoperation. The etiology of this phenomenon is unknown, although it has recently been associated with indolent Propionibacterium acnes infection. Case Description: A 59-year-old man initially presented with a traumatic acute subdural hematoma treated with emergent decompressive hemicraniectomy and hematoma evacuation. His bone flap was cryopreserved. He underwent cranioplasty with autologous bone 3 months later. Over the subsequent 14 months, serial imaging demonstrated progressive bone flap resorption, ultimately requiring repeat cranioplasty with a custom allograft. Although there was no evidence of infection at the time of repeat cranioplasty, routine culture swabs were taken and grew P. acnes after the patient had been discharged home. Pathologic analysis of the fragments of the original bone flap that were removed demonstrated osteonecrosis with marrow fibrosis but no evidence of inflammation or infection. He was treated with 6 weeks of intravenous antibiotics and had no evidence of infection at 8-month follow-up. Conclusions: Indolent P. acnes infection can precipitate autologous bone flap resorption. While the mechanism of this is unknown, pathologic analysis of a partially resorbed bone flap in the setting of an indolent P. acnes infection found no evidence of an infectious process or inflammation within the bone. Further studies are needed to elucidate the mechanism of action of P. acnes in bone flap resorption.

Original languageEnglish (US)
Pages (from-to)313-316
Number of pages4
JournalWorld neurosurgery
Volume138
DOIs
StatePublished - Jun 2020

Keywords

  • Bone flap
  • Cranioplasty
  • Propionibacterium acnes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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