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Pediatric Cranioplasty Patients With Hostile Reconstructive Environments: Split Calvarial Versus Prosthetic Implant
Kaitlin G Burge1, Edgar Soto1, Natalie Derise2
1From the Heersink School of Medicine.
Insights
This study found no significant difference in complications between prosthetic and autologous grafts for pediatric cranioplasty in complex settings. However, prior hemicraniectomy increased complication risk.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Pediatric cranial defects present complex reconstructive challenges due to factors like infection, radiation, or prior failed surgeries.
- Hostile reconstructive environments require careful consideration for optimal cranioplasty outcomes.
Purpose of the Study:
- To compare the outcomes of split-calvarial autologous grafts versus prosthetic grafts in pediatric cranioplasty within hostile reconstructive settings.
- To identify factors influencing complication rates in pediatric cranioplasty.
Main Methods:
- Retrospective chart review of 51 pediatric patients (<18 years) undergoing cranioplasty in a hostile setting (1998-2020).
- Patients stratified into prosthetic (45%) and autologous (54%) graft groups.
- Primary outcome: postoperative complications (defined as need for subsequent surgery or revision).
Main Results:
- No significant differences in complications (18% overall) between autologous and prosthetic graft groups.
- Specific complications included infection, graft failure, wound breakdown, and hematoma, with no group disparities.
- Patients requiring cranioplasty after hemicraniectomy showed a significantly higher risk of complications (P=0.045).
Conclusions:
- Prosthetic and autologous grafts demonstrate comparable complication rates in pediatric cranioplasty for hostile settings.
- Previous hemicraniectomy is a significant risk factor for postoperative complications in pediatric cranioplasty.
Introduction:
Pediatric cranial defects can be preceded by prior infection, radiation therapy, failed prior cranioplasty, or cerebrospinal fluid leak, leading to a complex reconstructive environment. The primary aim of this study was to investigate differences in outcomes between pediatric patients with hostile reconstructive environments who received split-calvarial autologous grafts as opposed to prosthetic grafts in cranioplasty.
Methods:
We performed an institutional review board-approved retrospective chart review of 51 patients younger than 18 years who underwent cranioplasty with a hostile setting between 1998 and 2020. Patients were then stratified into prosthetic (45%) and autologous groups (54%). The primary outcome measured was postoperative complication, defined as requirement of a subsequent surgery or revision.
Results:
Overall, there were no significant differences in age, sex, type of hostile setting, etiology of cranial defect, or side of the cranial defect between the 2 groups. Complication rate among the 2 graft groups was 18%. However, there were no significant differences in complications, defined as infection, failure or resorption of the graft, wound breakdown or necrosis, resulting bone defect, or hematoma, between the 2 populations. There was a significant difference in etiology between patients with complications, with patients who required a cranioplasty due to previous hemicraniectomy being nearly 5 times as likely to face a complication ( P = 0.045).
Conclusions:
In our study, there was no significant difference observed in complications between prosthetic and split-thickness autologous grafts in pediatric patients with hostile settings. It does, however, seem that patients who had a previous hemicraniectomy are more likely to face complications as a result of cranioplasty.
