Utilizing Computer-assisted Planning for Split Calvarial Bone Cranioplasty of an Infant With Occipital Langerhans...

Langerhans cell histiocytosis is frequently characterized by lytic calvarial lesions, periodically necessitating cranioplasty in infant patients. Split calvarial bone graft cranioplasty is a feasible, though technically challenging option, which may be augmented with computer-assisted planning. Our case concerns a 14-month-old boy who presented with rapid evolution of soft calvarial masses of the subocciput. Lesional aspiration was pathologically indeterminate, and lesional resection with histopathologic diagnosis and cranioplasty was planned. Virtual surgical planning allowed for identification of the most ideal harvest graft site for successful calvarial splitting. After successful lesional excision, the graft was harvested using custom manufactured osteotomy guides, split, and secured at both donor and lesion sites. The patient did well after surgery and subsequently began oncological chemotherapy. This report represents the unique description of computer-assisted planning applied to split calvarial bone grafting for the treatment of an infantile patient with calvarial Langerhans cell histiocytosis.