Comparison of autograft and implant cranioplasty in pediatrics: A meta-analysis
Dirga Rachmad Aprianto1, Muhammad Arifin Parenrengi1, Budi Utomo2
1Department of Neurosurgery, Dr. Soetomo General Academic Hospital.
Insights
Pediatric cranioplasty using autograft or implant materials shows no significant difference in infection or revision rates. This suggests implants are a viable option for cranial defects in children, pending further research.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Biomaterials Science
Background:
- Pediatric cranioplasty presents unique surgical challenges.
- The optimal material for pediatric cranial reconstruction remains debated, with limited comparative studies on autologous grafts versus implant materials.
Purpose of the Study:
- To evaluate and compare the risks of infection and revision surgery in pediatric patients undergoing cranioplasty with either autograft or implant materials.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA guidelines.
- Literature search across major databases (PubMed, Cochrane, Scopus, ScienceDirect) for studies from 2000-2021.
- Analysis of data from four selected publications on pediatric cranioplasty outcomes.
Main Results:
- Four studies, encompassing 126 cranioplasty procedures in 119 pediatric patients, were analyzed.
- No statistically significant difference was found in postoperative infection rates between autograft and implant cranioplasty groups.
- Similarly, the revision rates did not differ significantly between the two material groups.
Conclusions:
- Both autograft and implant cranioplasty demonstrate comparable postoperative infection and revision rates in pediatric patients.
- Implant-based cranioplasty is a feasible alternative for pediatric cranial defects, offering similar outcomes to autografts.
- Further large-scale studies are warranted to provide more detailed comparisons of autograft and implant materials in pediatric cranioplasty.
Background:
Cranioplasty in pediatrics is quite challenging and intricated. The ideal material for it is still debatable until now due to the limited study comparing autologous and implant grafts. This meta-analytic study was conducted to evaluate the risk of infection and revision in pediatric patients after autograft and implant cranioplasty.
Methods:
A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A thorough literature search was conducted on PubMed, Cochrane, Scopus, and ScienceDirect database. Articles published from 2000 to 2021 were selected systematically using PRISMA based on the predetermined eligibility criteria. The relevant data were, then, analyzed and discussed.
Results:
A total of four publications investigating the outcome of autograft and implant cranioplasty were included and reviewed. Postoperative infection and revision rate after 126 cranioplasty procedures (both autograft or implant) from 119 patients below 21 years during time frame of study were analyzed. This meta-analysis study showed that the rate of infection and revision after cranioplasty were not different between the autograft and implant groups.
Conclusion:
Autograft and implant cranioplasty have no significant difference in postoperatively infection and revision rate. This study showed that cranioplasty using implant is a plausible option in pediatric patients with cranial defects, depending on the patients' condition due to similar outcome with autograft cranioplasty. Further studies with larger population and more specific details are necessary to determine the comparison of autograft and implant material in cranioplasty procedure.
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