To describe a case of autologous skull graft resorption (ASGR) in a patient with prior ventriculoperitoneal (VP) shunt and to review existing literature on ASGR.
Approach:
Case Description: A 27-year-old male underwent emergency procedures for spontaneous intracerebral hemorrhage and later received autologous cranioplasty. Follow-up CT scans were used to monitor ASGR over three years.
Follow-up and Imaging: Serial cranial CT imaging was performed at 3 months, 6 months, 1 year, and 3 years to quantify resorption and identify regional patterns.
Key Findings:
ASGR progressed from 12.3% at 6 months to 58.2% at 3 years, with significant regional predominance in the occipital area.
Shunt pressure adjustments from 80 mmH₂O to 120 mmH₂O correlated with a reduction in ASGR progression.
Interpretation:
Chronic intracranial hypotension is a primary driver of ASGR in patients with VP shunts, and individualized management through shunt pressure optimization can effectively slow resorption.
Limitations:
Long-term follow-up data and optimal management strategies for ASGR in VP-shunted patients are poorly defined.
The case study is based on a single patient, limiting generalizability.
Conclusion:
Long-term conservative surveillance with individualized shunt pressure titration is safe and effective for asymptomatic moderate-to-severe ASGR.
