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Beyond decompression: predictors of cranioplasty failure in pediatric patients - a meta-analysis
Ehab Shabo1, Ömer Can Yildiz2,3, Christian Wispel4
1Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. Ehab.Shabo@ukbonn.de.
Insights
Pediatric cranioplasty has high complication rates, with nearly 30% bone resorption and 10% infection. Early intervention and titanium fixation may improve outcomes for children undergoing this procedure.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Regenerative Medicine
Background:
- Pediatric cranioplasty after decompressive craniectomy has high complication rates, including bone resorption and infection.
- Children present unique challenges, and autologous bone graft alternatives are limited.
- This meta-analysis evaluates pediatric cranioplasty outcomes and predictors of complications.
Purpose of the Study:
- To evaluate the current state of pediatric cranioplasty.
- To identify key predictors of bone resorption and infection.
- To assess outcomes and guide future clinical improvements.
Main Methods:
- Systematic search of MEDLINE/PubMed and Web of Knowledge.
- Included studies reporting quantitative outcomes in pediatric populations.
- Risk of bias assessed using ROBINS-I tool.
Main Results:
- Seven retrospective case series (594 patients) analyzed; average age 8.4 years.
- Bone resorption rate ~30%, infection rate ~10%.
- Delayed cranioplasty, large defect area, cerebral contusion, comminuted fractures predicted resorption. Shunts, implants, non-titanium fixation increased infection/resorption.
Conclusions:
- Pediatric cranioplasty has unacceptably high complication rates.
- Early intervention and titanium fixation may reduce reoperation rates.
- Further prospective studies needed for standardized protocols and alternative materials.
Background:
Pediatric cranioplasty following decompressive craniectomy is associated with high complication rates, particularly bone resorption and infection. Unlike adult populations, children face unique anatomical and physiological challenges, and the lack of viable alternatives to autologous bone graft further complicates outcomes. This meta-analysis aims to evaluate the current state of pediatric cranioplasty, identifying key predictors of bone resorption and infection, and assessing outcomes to guide future clinical improvements.
Methods:
A systematic search was conducted in MEDLINE/PubMed and Web of Knowledge using combinations of the terms "cranioplasty," "pediatric," "children," and "decompressive craniectomy." Studies were included if they reported quantitative data on outcomes in pediatric populations. Risk of bias were assessed using the ROBINS-I tool.
Results:
Seven retrospective case series encompassing 594 patients were analysed. The average age of patients was 8.4 years, with a mean follow-up of 37.8 months. The mean time from craniectomy to cranioplasty was 12.5 weeks. Autologous bone graft was used in 77.6% of cases. The rate of bone resorption requiring reoperation approached 30%, and infection occurred in approximately 10% of patients. Delayed cranioplasty (> 6 weeks), large skull defect area, underlying cerebral contusion, and comminuted fractures significantly predicted bone graft resorption. The use of ventriculoperitoneal shunts, cranial implants, and non-titanium fixation materials were associated with higher infection and resorption rates.
Conclusion:
Pediatric cranioplasty carries unacceptably high complication rates for an elective procedure. Early intervention and the use of titanium fixation may reduce the burden of reoperation. Further prospective studies are necessary to establish standardized surgical protocols and explore alternative materials.
