Foreign Body Reaction Following Use of a Novel Bone Graft Substitute in Pediatric Cranioplasty

Pediatric cranioplasty is indicated to repair skull defects with a wide variety of etiologies. The choice of graft material used to fill the defect is of paramount importance to the long-term success of this procedure. A variety of synthetic products have been commercially developed to avoid donor site morbidity. Here, the authors present the case of a 13-year-old boy with cranial Langerhans cell histiocytosis who underwent cranioplasty with a novel, calcium phosphate-based bone graft substitute (Montage). The patient presented 2 years postoperatively with a foreign body giant cell reaction that required explantation of the graft. The authors discuss potential considerations in choosing the most appropriate graft, potential contributors to this late adverse outcome, and the need for further research into the use of novel allograft materials in pediatric cranioplasty.