Sonolucent Cranioplasties in Young Children: Technical Nuances and Challenges

Cranioplasty, the surgical repair of cranial defects, aims to restore the structural integrity and aesthetic appearance of the skull. The choice of implant material is crucial and influenced by factors such as fit, risk of infection, and postoperative monitoring. Pediatric patients pose unique challenges in cranioplasty because of ongoing skull growth, bone resorption, and higher complication rates. This case report highlights the use of ClearFit^© (Longeviti Neuro Solutions), a polymethyl methacrylate-based sonolucent implant, as a novel approach to pediatric cranioplasty with sonolucent properties to enhance postoperative imaging and monitoring capabilities, compatible with ultrasound monitoring.

A 2-year-old male patient with a traumatic brain injury and resulting sunken cranial defect underwent cranioplasty using a ClearFit implant (the youngest reported use of this technology to-date). The implant demonstrated successful integration and a favorable surgical outcome. One year after surgery, the polymethyl methacrylate-based sonolucent implant yields good clinical outcomes without postsurgical complication, allowing postoperative monitoring without radiation exposure even after fontanelle closure. When used alongside porous polyethylene strips, it may also support ongoing skull growth.

This case supports the use of ClearFit as a viable option over traditional materials-particularly in young patients who may be at a higher risk of bone resorption with autologous grafts and will need postoperative intracranial monitoring.