Spontaneous Bone Regeneration After Large Craniectomy in Pediatric Patient

In children, decompressive craniectomy is commonly performed in cases of increased intracranial pressure that is not medically managed. Currently, it is standard practice to perform cranioplasty after decompressive craniectomy, although optimal timing for the procedure remains controversial. To date, few studies have reported spontaneous cranial bone regeneration in children without intervention.

A 7-year-old female presented with frontotemporal bone fractures accompanied by dura mater lacerations and brain edema after a motor vehicle accident. She underwent a large decompressive craniectomy and repair of the lacerated dura with a collagen dural substitute. The patient was discharged from the hospital and did not present for follow-up until 10 months after surgery. At that time, computed tomography imaging revealed remarkable spontaneous bone regeneration. With conservative management, she developed enough bone regeneration in the calvarial defect area that cranioplasty surgery was deemed unnecessary. To this date, the patient has no aesthetic deformation of the skull bone and does not exhibit any residual cognitive impairment or motor deficits.

This case report shows that cranial bone regeneration is possible in children older than 6 years old, bypassing the need for cranioplasty after decompressive craniectomy. On the basis of this observation, we recommend that more studies should be performed to identify the factors involved in spontaneous skull bone regeneration in the pediatric population.