Safety and Efficacy of Autologous Calvarial Graft Reconstruction for Large Cranial Defects in Pediatric Patients

Reconstruction of cranial defects using autologous calvarial grafts offers long-term advantages over alloplastic alternatives, especially in pediatric patients. However, the effectiveness of this method has been questioned for larger defects. This study evaluates outcomes after cranial reconstructions with fresh autologous calvarial grafts in pediatric patients. Medical records of pediatric patients who underwent cranioplasty with fresh autologous calvarial grafts at our institution over 10 years (2012-2022) were reviewed. The area of the bone defect and degree of postoperative osseus healing was determined clinically or by using 3-dimensional computed tomography (CT) when available. Secondary outcomes, including complications, unanticipated readmissions, and reoperation rates, were assessed. Twenty-seven patients, with a median age of 9.8 years at the time of reconstruction, were included. There were no infections, cerebrospinal fluid leaks, readmissions, or reoperations reported. At a median of 51 months postoperatively, only one patient (3.7%) exhibited a clinically appreciable bone defect. Postoperative CT, obtained at a median of 24 months, was available for thirteen patients (48.1%). These patients had a median bone healing rate of 84.1%. Incomplete bone healing correlated with larger initial defects (median: 24; IQR: 20-40.6 cm 2 vs. 260.4; IQR: 198-302 cm 2 ; P =0.002] and a higher number of previous craniofacial procedures ( P =0.032). Cranioplasty using fresh autologous bone graft is safe and effective, with a median clinical bone healing rate of 96.3% and radiographic bone healing rate of 84.1%. Patients with a higher number of previous cranial procedures and a larger initial defect size are at higher risk of incomplete bone healing.