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Considerations for Choice of Cranioplasty Material for Pediatric Patients
Megan E H Still1, Sonja Samant2, Abraham Alvarado3
1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Florida, Gainesville, Florida, USA, megan.still@ufl.edu.
Insights
Pediatric cranioplasty using autologous bone or alloplastic materials shows good outcomes. Younger children, craniosynostosis diagnosis, and autologous bone increase revision risk.
Area of Science:
- Pediatric neurosurgery
- Craniofacial surgery
- Biomaterials in medicine
Background:
- Cranioplasty material and timing in pediatric patients remain subjects of debate.
- Both autologous and alloplastic materials present distinct indications and complication risks.
Purpose of the Study:
- To evaluate outcomes of cranioplasty in pediatric patients.
- To identify factors influencing revision surgery and implant removal.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing cranioplasty between 1991 and 2021.
- Inclusion of 149 cranioplasty implants for analysis.
Main Results:
- Younger age (≤6 years), craniosynostosis diagnosis, autologous bone use, and shorter time to cranioplasty predicted revision surgery.
- No studied factors significantly impacted implant removal rates during revision.
Conclusions:
- Both autologous and alloplastic cranioplasty materials demonstrate favorable outcomes with low revision rates in pediatric patients.
- Alloplastic implants may be advantageous in cases of infection-related craniectomy due to lower revision and removal rates.
- Cranioplasty for craniosynostosis is associated with a higher risk of revision surgery, irrespective of the implant material.
Introduction:
Optimal material and timing of cranioplasty in the pediatric population continue to be debated. Autologous and alloplastic materials have various indications for use and risk factors for complications.
Methods:
A single-center retrospective cohort study was undertaken of all pediatric patients who underwent cranioplasty with any material from 1991-2021.
Results:
149 cranioplasty implants were included. Younger age (6 years old or under), a diagnosis of craniosynostosis as reason for implant, use of autologous bone, and shorter times to cranioplasty were predictive of need for revision surgery. No factors studied had a statistically significant impact on rate of removal of implant at time of revision surgery.
Conclusion:
Autologous and alloplastic cranioplasty materials both have good outcomes with low rates of revision surgery in the pediatric population. Alloplastic implants may be considered in the setting of infection as reason for craniectomy given the lower rate of revision surgery and need for removal. Patients with craniosynostosis as reason for cranioplasty have a higher risk of requiring revision or additional surgeries, regardless of implant used.
