Cranioplasty after craniectomy in pediatric patients—a systematic review
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Complications following cranioplasty with either autografts or cranial implants are commonly reported in pediatric patients. However, data regarding cranioplasty strategies, complications and long-term outcomes are not well described. This study systematically reviews the literature for an overview of current cranioplasty practice in children.
A systematic review of articles published from inception to July 2018 was performed. Studies were included if they reported the specific use of cranioplasty materials following craniectomy in patients younger than 18 years of age, and had a minimum follow-up of at least 1 year.
Twenty-four manuscripts, describing a total of 864 cranioplasty procedures, met the inclusion criteria. The age of patients in this aggregate ranged from 1 month to 20 years and the weighted average was 8.0 years. The follow-up ranged from 0.4 months to 18 years and had a weighted average of 40.4 months. Autologous bone grafts were used in 484 cases (56.0%). Resorption, infection and/or hydrocephalus were the most frequently mentioned complications. In this aggregate group, 61 patients needed a revision cranioplasty. However, in 6/13 (46%) papers studying autologous cranioplasties, no data was provided on resorption, infection and revision cranioplasty rates. Cranial implants were used in 380 cases (44.0%), with custom-made porous hydroxyapatite being the most commonly used material (100/380, 26.3%). Infection and migration/fracturing/loosening were the most frequently documented complications. Eleven revision cranioplasties were reported. Again, no data was reported on infection and revision cranioplasty rates, in 7/16 (44%) and 9/16 (56%) of papers, respectively.
Our systematic review illuminates that whether autografts or cranial implants are used, postcranioplasty complications are quite common. Beyond this, the existing literature does not contain well documented and comparable outcome parameters, suggesting that prospective, long-term multicenter cohort studies are needed to be able to optimize cranioplasty strategies in children who will undergo cranioplasty following craniectomy.
KeywordsCraniectomy Cranioplasty Children Pediatric neurosurgery
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 with the research ethical guidelines.
- 8.Chao MT, Jiang S, Smith D, DeCesare GE, Cooper GM, Pollack IF, Girotto J, Losee JE (2009) Demineralized bone matrix and resorbable mesh bilaminate cranioplasty: a novel method for reconstruction of large-scale defects in the pediatric calvaria. Plast Reconstr Surg 123:976–982. https://doi.org/10.1097/PRS.0b013e31819ba46f CrossRefPubMedGoogle Scholar
- 16.Fiaschi P, Pavanello M, Imperato A, Dallolio V, Accogli A, Capra V, Consales A, Cama A, Piatelli G (2016) Surgical results of cranioplasty with a polymethylmethacrylate customized cranial implant in pediatric patients: a single-center experience. J Neurosurg Pediatr 17:705–710. https://doi.org/10.3171/2015.10.PEDS15489 CrossRefPubMedGoogle Scholar
- 19.Frassanito P, Massimi L, Tamburrini G, Bianchi F, Nataloni A, Canella V, Caldarelli M (2018) Custom-made hydroxyapatite for cranial repair in a specific pediatric age group (7-13 years old): a multicenter post-marketing surveillance study. Childs Nerv Syst 34:2283–2289. https://doi.org/10.1007/s00381-018-3905-8 CrossRefGoogle Scholar
- 24.Gilardino MS, Karunanayake M, Al-Humsi T, Izadpanah A, Al-Ajmi H, Marcoux J, Atkinson J, Farmer JP (2015) A comparison and cost analysis of cranioplasty techniques: autologous bone versus custom computer-generated implants. J Craniofac Surg 26:113–117. https://doi.org/10.1097/SCS.0000000000001305 CrossRefPubMedGoogle Scholar
- 34.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
- 37.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
- 44.Rocque BG, Agee BS, Thompson EM, Piedra M, Baird LC, Selden NR, Greene S, Deibert CP, Hankinson TC, Lew SM, Iskandar BJ, Bragg TM, Frim D, Grant G, Gupta N, Auguste KI, Nikas DC, Vassilyadi M, Muh CR, Wetjen NM, Lam SK (2018) Complications following pediatric cranioplasty after decompressive craniectomy: a multicenter retrospective study. J Neurosurg Pediatr 8:1–8. https://doi.org/10.3171/2018.3.PEDS17234 CrossRefGoogle Scholar