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Outcomes of cranioplasty following decompressive craniectomy in the pediatric population
Brandon G Rocque1, Kaushik Amancherla, Sean M Lew
1Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, USA.
Insights
This review of pediatric cranioplasty found cryopreserved bone flaps may increase resorption and infection risk. Early surgery and fresh autografts may reduce complications, but more research is needed.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Cranioplasty is common after decompressive craniectomy in children.
- Adult cranioplasty has higher complication rates than elective cranial surgery.
- Risk factors for pediatric cranioplasty complications require further investigation.
Purpose of the Study:
- To review literature on risk factors for pediatric cranioplasty complications.
- To analyze outcomes based on bone flap storage, timing, and material.
- To identify areas for future research in pediatric cranioplasty.
Main Methods:
- Systematic literature search of PubMed, Cochrane, and SCOPUS.
- Inclusion of studies focusing on pediatric cranioplasty, excluding case reports.
- Analysis of 11 studies involving 441 pediatric cranioplasties.
Main Results:
- Cryopreserved bone flaps may increase resorption and infection risk compared to room-temperature storage.
- Timing of cranioplasty showed no significant effect in most studies, but early surgery may reduce resorption.
- Insufficient data on material effects for decompressive craniectomy defects; fresh autografts may reduce resorption for other indications.
- Defect size and patient age did not significantly impact complication rates.
Conclusions:
- Bone flap preservation method and timing of surgery may influence pediatric cranioplasty outcomes.
- Further large-scale prospective and retrospective studies are essential.
- Understanding these factors can optimize pediatric cranioplasty safety and efficacy.
Abstract:
Cranioplasty is routinely performed following decompressive craniectomy in both adult and pediatric populations. In adults, this procedure is associated with higher rates of complications than is elective cranial surgery. This study is a review of the literature describing risk factors for complications after cranioplasty surgery in pediatric patients. A systematic search of PubMed, Cochrane, and SCOPUS databases was undertaken. Articles were selected based on their titles and abstracts. Only studies that focused on a pediatric population were included; case reports were excluded. Studies in which the authors assessed bone flap storage method, timing of cranioplasty, material used (synthetic vs autogenous), skull defect size, and/or complication rates (bone resorption and surgical site infection) were selected for further analysis. Eleven studies that included a total of 441 cranioplasties performed in the pediatric population are included in this review. The findings are as follows: 1) Based on analysis of pooled data, using cryopreserved bone flaps during cranioplasty may lead to a higher rate of bone resorption and lower rate of infection than using bone flaps stored at room temperature. 2) In 3 of 4 articles describing the effect of time between craniectomy and cranioplasty on complication rate, the authors found no significant effect, while in 1 the authors found that the incidence of bone resorption was significantly lower in children who had undergone early cranioplasty. Pooling of data was not possible for this analysis. 3) There are insufficient data to assess the effect of cranioplasty material on complication rate when considering only cranioplasties performed to repair decompressive craniectomy defects. However, when considering cranioplasties performed for any indication, those in which freshly harvested autograft is used may have a lower rate of resorption than those in which stored autograft is used. 4) There is no appreciable effect of craniectomy defect size or patient age on complication rate. There is a paucity of articles describing outcomes and complications following cranioplasty in children and adolescents. However, based on the studies examined in this systematic review, there are reasons to suspect that method of flap preservation, timing of surgery, and material used may be significant. Larger prospective and retrospective studies are needed to shed more light on this important issue.
