Custom-made hydroxyapatite for cranial repair in a specific pediatric age group (7–13 years old): a multicenter post-marketing surveillance study
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CustomBone Service (CBS) is a patient-specific, biocompatible, and osteoconductive device made of porous hydroxyapatite, indicated for cranial reconstruction in adults and children. Adult literature data report a failure rate of about 8%. The aim of this Post-Marketing Surveillance study is to verify the hypothesis that CBS in children aged 7–13 years old shows a failure rate not superior to adults.
Materials and methods
Inclusion criteria were age at implantation ranging 7–13 years old, with at least 1 year elapsed from the date of surgery. The degree of satisfaction of surgeons and patients was assessed.
Data about 76 implants in 67 patients (M:F = 41:26) were obtained from 28 centers across 7 European countries. The mean age at surgery was 10.03 ± 1.72 years, with age stratification almost equally distributed. Fifty-nine subjects received one CBS, 7 subjects two and one subject received three CBS. Main etiologies were trauma (60.5%), malformation (11.8%), bone tumor (10.5%), and cerebral tumor (7.9%). Main indications to CBS were decompression (47.4%), autologous bone resorption (18.4%), tumor resection (11.8%), malformation (9.2%), comminuted fracture (5.3%), and other materials rejection (5.3%). Main implantation sites were fronto-parieto-temporal (26.3%), parietal (23.7%), frontal (11.8%), fronto-temporal (10.5%), and parieto-temporal (7.9%). CBS was chosen as first line of treatment in 63.1% of the cases. Mean follow-up was about 36 months. Eleven adverse events (14.5%) were reported in nine devices. Five CBS required explantation (three cases of infection, one fracture, and one mobilization). Failure rate was 6.58%, which is statistically not superior to the explantation rate recorded in adults (two-sided 95%, CI 2.2–14.7%). Satisfaction of surgeons and patients was of about 95%.
CBS is a safe and effective solution for cranial repair in pediatric patients. In particular, over the age of 7, CBS shows a rate of failure as low as in adults.
KeywordsCranioplasty Custombone Decompressive craniectomy Precision medicine
Compliance with ethical standards
Conflict of interest
Paolo Frassanito received a grant from Fin-ceramica Faenza S.p.A.
Angelo Nataloni and Valentina Canella are fully employed at Fin-Ceramica Faenza S.p.A.
No competing financial interests exist for the remaining authors.
- 3.Staffa G, Barbanera A, Faiola A, Fricia M, Limoni P, Mottaran R, Zanotti B, Stefini R (2012) Custom made bioceramic implants in complex and large cranial reconstruction: a two-year follow-up. J Cranio-Maxillo-fac Surg Off Publ Eur Assoc Cranio-Maxillo-fac Surg 40:e65–e70. https://doi.org/10.1016/j.jcms.2011.04.014 CrossRefGoogle Scholar
- 8.Stefini R, Esposito G, Zanotti B, Iaccarino C, Fontanella MM, Servadei F (2013) Use of “custom made” porous hydroxyapatite implants for cranioplasty: postoperative analysis of complications in 1549 patients. Surg Neurol Int 4:12. https://doi.org/10.4103/2152-7806.106290 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Martin KD, Franz B, Kirsch M, Polanski W, von der Hagen M, Schackert G, Sobottka SB (2014) Autologous bone flap cranioplasty following decompressive craniectomy is combined with a high complication rate in pediatric traumatic brain injury patients. Acta Neurochir 156:813–824. https://doi.org/10.1007/s00701-014-2021-0 CrossRefPubMedGoogle Scholar
- 15.Morice A, Kolb F, Picard A, Kadlub N, Puget S (2017) Reconstruction of a large calvarial traumatic defect using a custom-made porous hydroxyapatite implant covered by a free latissimus dorsi muscle flap in an 11-year-old patient. J Neurosurg Pediatr 19:51–55. https://doi.org/10.3171/2016.8.PEDS1653 CrossRefPubMedGoogle Scholar
- 22.Iaccarino C, Mattogno PP, Zanotti B, et al (2016) Septic complication following porous hydroxyapatite cranioplasty: prosthesis retention management. J Neurosurg SciGoogle Scholar
- 23.Wehrli LA, Zweifel N, Weil R, Altermatt S (2012) Juvenile psammomatoid ossifying fibroma of the forehead, radical resection, and defect coverage with a hydroxyl-apatite composite-a case report. Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg Al Z Für Kinderchir 22:479–484. https://doi.org/10.1055/s-0032-1313349 CrossRefGoogle Scholar
- 24.F-C Faenza, Data on file, pending publicationGoogle Scholar