Minimizing bone gaps when using custom pediatric cranial implants is associated with implant success

Area of Science:

• Neurosurgery
• Biomaterials Science
• Pediatric Surgery

Background:

• Delayed cranioplasty is sometimes necessary after craniotomy due to bone flap resorption or discard.
• Polyetheretherketone (PEEK) and hard-tissue replacement patient-matched implants (HTR-PMI) are common choices for these delayed reconstructions.
• Identifying factors influencing the success of these artificial implants in pediatric patients is crucial.

Purpose of the Study:

• To compare the failure rates of PEEK and HTR-PMI implants in pediatric cranioplasty.
• To identify specific risk factors associated with artificial implant failure in this population.

Main Methods:

• A retrospective cohort study analyzed pediatric patients who received PEEK or HTR-PMI implants between 2000 and 2013.
• Variables including age, sex, mechanism of injury, surgeon, hydrocephalus, time to cranioplasty, bone gap width, and implant type were examined.
• Implant failure, defined as removal and replacement, was analyzed using bivariate and multivariate logistic regression.

Main Results:

• Overall implant success rate was 78.3%.
• PEEK (78.6%) and HTR-PMI (78.1%) implants demonstrated comparable success rates (p = 0.96).
• A bone gap greater than 6 mm was associated with a significantly lower success rate (33.3% vs. 82.5%, p = 0.02) and was the only independent risk factor for failure in multivariate analysis (OR 8.3).

Conclusions:

• Both PEEK and HTR-PMI implants are equally effective for custom pediatric cranioplasty.
• A bone gap exceeding 6 mm is a significant predictor of artificial implant failure in pediatric patients requiring custom implants.