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Outcomes of Titanium Mesh Cranioplasty in Pediatric Patients
Irene T Ma1, Melissa R Symon2, Ruth E Bristol3
1Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ.
Insights
Titanium mesh cranioplasty (TMC) effectively reconstructs pediatric cranial defects when autologous bone is limited. This study shows favorable outcomes with good symmetry and brain protection, despite minor complications.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Reconstruction
- Biomaterials in Medicine
Background:
- Cranial defects in children require reconstruction using various materials.
- Limited literature exists on titanium mesh cranioplasty (TMC) outcomes in pediatric patients.
- This study addresses the efficacy of TMC in pediatric calvarial reconstruction.
Purpose of the Study:
- To evaluate the outcomes of titanium mesh cranioplasty (TMC) in pediatric patients with calvarial defects.
- To assess the efficacy and safety of TMC in this specific population.
- To provide data on TMC as an alternative to autologous bone grafts.
Main Methods:
- Retrospective review of patients aged 18 years or younger who underwent cranioplasty between 1999 and 2014.
- Focus on a cohort of 33 pediatric patients who underwent titanium mesh cranioplasty.
- Data collected on etiologies, prior surgeries, mesh characteristics, complications, and follow-up.
Main Results:
- Titanium mesh cranioplasty (TMC) was performed on 33 pediatric patients, with congenital syndromes and trauma as common etiologies.
- Most patients had prior cranial surgeries; various mesh sizes were utilized.
- Low complication rates were observed, with 2 patients experiencing perioperative issues and 2 late soft tissue problems. All patients achieved good cranial contour and brain protection.
Conclusions:
- Titanium mesh cranioplasty (TMC) is a viable and effective option for pediatric cranial defects, especially when autologous bone is insufficient.
- The interim outcomes are favorable, with minimal complications and no observed growth restriction.
- Continued long-term follow-up is planned for these patients.
Purpose:
Cranial defects in children have been repaired with various materials ranging from autologous bone to synthetic materials. There is little published literature on the outcomes of titanium mesh cranioplasty (TMC) in calvarial reconstruction in the pediatric population. This study evaluates a pediatric cohort who underwent calvarial defect reconstruction with titanium mesh and assesses the efficacy and outcomes of TMC.
Methods:
An Institutional Review Board approved retrospective review of patients ≤18 years of age who underwent cranioplasty from 1999 to 2014 at 2 centers was performed. The cohort undergoing TMC was studied.
Results:
A total of 159 cranioplasties were performed. Autologous reconstruction included 84 bone flap replacements and 36 split calvarial bone graft reconstructions. Six patients underwent PEEK implant reconstruction. Titanium mesh cranioplasty was performed on 33 patients. Two patients underwent 2 separate cranioplasties. The median age of patients was 6 years (19 months to 18 years). The most common underlying etiologies were congenital syndromes/craniosynostosis (13 patients), and trauma (11). The majority of patients had prior cranial surgeries (85%). Various types of titanium mesh were used with sizes ranging from 2×3 cm to 19×20 cm, with some patients requiring distinct areas of defect reconstruction. Perioperative complications were noted in 2 patients that subsequently improved. Two patients had late soft tissue problems with complications of wound infections requiring resection of a portion of the mesh. Patients were followed an average of 4 years (range 13 days to 6.8 years), with 2 patients lost to follow-up. Overall, all patients with follow-up achieved a cranial contour with good symmetry to the unaffected side, as well as effective protection to the brain.
Conclusions:
Titanium mesh cranioplasty is an effective option for correcting pediatric cranial defects when autologous bone availability is limited and soft tissue coverage allows placement of an implant. The interim outcome for these patients is favorable with few complications and no evidence of growth restriction in the authors' series. Follow-up will be ongoing for these patients.
