International Surgery Journal | September 2019 | Vol 6 | Issue 9 Page 3251 International Surgery Journal Singh S et al. Int Surg J. 2019 Sep;6(9):3251-3257 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Original Research Article Autologous bone reconstruction as sandwich technique in pediatric posterior fossa surgery: finding a noble eightfold path for developing countries Suyash Singh, Kamlesh Singh Bhaisora, Arun Kumar Srivastava*, Sanjay Behari INTRODUCTION Sub-occipital craniotomy in pediatric population is difficult owing to uneven surface of growing calvaria and thin dura. The sandwich technique is the plausible answer to the unsolved debate between “craniectomy” and “craniotomy”, especially for paediatric posterior fossa (PPF) surgery. 1 The bony reconstruction, either with autologous chips or metallic implants, is credited with lower post-operative complications. 1,2 The technical familiarity ad ease in doing craniectomy creates a disfavour for micro drills and craniotomies. Objective In our article, we have attempted to restate the craniectomy for PPF tumors using the novel sandwich closure technique. The technique embraces autologous ABSTRACT Background: Sub-occipital craniotomy in pediatric population is difficult owing to uneven surface of growing calvaria and thin dura. Our novel technique using autologous bone chips and gelfoam bridges the two standard techniques. In this study, we intend to compare the surgical outcome in pediatric posterior fossa tumours. Methods: We included patients, operated via midline sub-occipital approach, from January 2013 to October 2018 and grouped them, on basis of whether or not sandwich reconstruction was done. We compared pseudomeningocele, post- operative headache, CSF leakage and postoperative hydrocephalus requiring CSF diversion. The aesthetic outcome was assessed using Stony Brook scar evaluation scale (SBSES). Results: 124 patients, divided into group A (n=53), group B (n=58) and group C (n=13) based on technique of surgical closure. The sandwich closure is significantly better in terms of both aesthesis and post-operative pain (p<0.05). There was a trend showing that sandwich closure decreases risk for pseudomeningocoele, wound infection, CSF leak and post-operative hydrocephalus. Median SBSES Score in group B was 4 compared to 2 in group A and patients were significantly more satisfied. Conclusions: The uniform bone coverage with sandwich closure provides nearly similar reconstruction to craniotomy. All risks of using drill over pediatric calvaria are eliminated and advantages are carried. The bony barrier prevents adhesion and decreases both immediate and delayed headache. The technique is not only technically easier and aesthetically better, but also has better long term satisfactory results with possibility of neo-bone formation. Keywords: Stony Brook scar evaluation scale, Delayed dragging headache, Satisfaction score, Neo bone Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India Received: 20 June 2019 Revised: 07 August 2019 Accepted: 09 August 2019 *Correspondence: Dr. Arun Kumar Srivastava, E-mail: doctorarun1008@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20194061