Cranioplasty following decompressive craniectomy (DC) has a primary complication when using the autologous bone: aseptic bone resorption (ABR). So far, risk factors such as age, number of fragments, and hydrocephalus have been identified but a thorough understanding of the underlying pathophysiology is still missing. The aim of this osteopathological investigation was to gain a better understanding of the underlying processes. Clinical data of patients who underwent surgical revision due to ABR was collected. Demographics, the time interval between craniectomy and cranioplasty, and endocrine serum parameters affecting bone metabolism were collected. Removed specimens underwent qualitative and quantitative histological examination. Two grafts without ABR were examined as controls. Compared to the controls, the typical layering of the cortical and cancellous bone was largely eliminated in the grafts. Histological investigations revealed the coexistence of osteolytic and osteoblastic activity within the necrosis. Bone appositions were distributed over the entire graft area. Remaining marrow spaces were predominantly fibrotic or necrotic. In areas with marrow cavity fibrosis, hardly any new bone tissue was found in the adjacent bone, while there were increased signs of osteoclastic resorption. Insufficient reintegration of the flap may be due to residual fatty bone marrow contained in the bone flap which seems to act as a barrier for osteogenesis. This may obstruct the reorganization of the bone structure, inducing aseptic bone necrosis. Following a path already taken in orthopedic surgery, thorough lavage of the implant to remove the bone marrow may be a possibility, but will need further investigation.

使用自体骨时，减压颅骨切除术 (DC) 后的颅骨成形术有一个主要并发症：无菌性骨吸收 (ABR)。到目前为止，已经确定了年龄、碎片数量和脑积水等风险因素，但仍缺乏对潜在病理生理学的透彻了解。这项骨病理学调查的目的是更好地了解潜在的过程。收集了因 ABR 进行手术翻修的患者的临床数据。收集人口统计学、颅骨切除术和颅骨成形术之间的时间间隔以及影响骨代谢的内分泌血清参数。取出的标本进行定性和定量组织学检查。检查没有 ABR 的两个移植物作为对照。与对照相比，在移植物中，皮质骨和松质骨的典型分层在很大程度上被消除了。组织学研究揭示了坏死中溶骨活性和成骨细胞活性的共存。骨并列分布在整个移植区域。剩余的骨髓腔主要是纤维化或坏死。在骨髓腔纤维化的区域，在邻近的骨骼中几乎没有发现任何新的骨组织，而破骨细胞吸收的迹象增加。骨瓣重新整合不充分可能是由于骨瓣中含有残留的脂肪骨髓，这似乎是成骨的障碍。这可能会阻碍骨结构的重组，导致无菌性骨坏死。沿着整形外科已经走过的道路，