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Cranioplasties following craniectomies in children—a multicenter, retrospective cohort study

  • Vita M. Klieverik
  • Kai J. Miller
  • Kuo Sen Han
  • Ash Singhal
  • Michael Vassilyadi
  • Charles J. Touchette
  • Alexander G. Weil
  • Peter A. WoerdemanEmail author
Original Paper
  • 73 Downloads

Abstract

Objective

Complications following pediatric cranioplasty after craniectomy with either autologous bone flaps or cranial implants are reported to be common, particularly bone flap resorption. However, only sparse data are available regarding cranioplasty strategies, complications, and outcomes. This manuscript describes a Canadian-Dutch multicenter pediatric cohort study with autografts and cranial implant cranioplasties following craniectomies for a variety of indications.

Methods

The study included all children (< 18 years) who underwent craniectomy and subsequent cranioplasty surgeries from 2008 to 2014 (with a minimum of 1-year follow-up) at four academic hospitals with a dedicated pediatric neurosurgical service. Data were collected regarding initial diagnosis, age, time interval between craniectomy and cranioplasty, bone flap storage method, type of cranioplasty for initial procedure (and redo if applicable), and the postoperative outcome including surgical site infection, wound breakdowns, bone flap resorption, and inadequate fit/disfigurement.

Results

Sixty-four patients (46 males, average age 9.7 ± 5.5 years) were eligible for inclusion, with mean follow-up of 82.3 ± 31.2 months after craniectomy. Forty cranioplasties (62.5%) used autologous bone re-implant, 23 (57.5%) of which showed resorption. On average, resorption was documented at 434 days (range 62–2796 days) after reimplantation. In 20 cases, a revision cranioplasty was needed. In 24 of the post-craniectomy cases (37.5%), a cranial implant was used with one of ten different implant types. Implant loosening prompted a complete revision cranioplasty in 2 cases (8.3%). Cranial implants were associated with low morbidity and lower reoperation dates compared to the autologous cranioplasties.

Conclusion

The most prominent finding in this multicenter cohort study was that bone flap resorption in children remains a common and widespread problem following craniectomy. Cranioplasty strategies varied between centers and evolved over time within centers. Cranial implants were associated with low morbidity and low reoperation rates. Still, longer term and prospective multicenter cohort studies are needed to optimize cranioplasty strategies in children after craniectomies.

Keywords

Cranial reconstruction Long-term Complications Pediatric neurosurgery 

Notes

Acknowledgements

KJM is supported by the Van Wagenen Foundation.

Compliance with ethical standards

Conflict of interest

With the submission of this manuscript, I would like to state that the authors report no conflict of interest concerning the materials and methods used or the findings specified in this paper. Furthermore, the authors declare that this study was performed in accordance to the research ethical guidelines.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Vita M. Klieverik
    • 1
  • Kai J. Miller
    • 1
  • Kuo Sen Han
    • 1
  • Ash Singhal
    • 2
  • Michael Vassilyadi
    • 3
  • Charles J. Touchette
    • 4
  • Alexander G. Weil
    • 4
  • Peter A. Woerdeman
    • 1
    Email author
  1. 1.Department of Neurosurgery, Division of Neuroscience, Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Division of Pediatric NeurosurgeryBritish Columbia Children’s HospitalVancouverCanada
  3. 3.Division of NeurosurgeryChildren’s Hospital of Eastern OntarioOttawaCanada
  4. 4.Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine HospitalUniversity of MontrealMontrealCanada

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