Abstract
Background and Study Aims/Objective Cranioplasty, a common neurosurgical intervention following decompressive craniectomy
(DC), is associated with high complication rates. Bone flap resorption in particular
leads to a considerable number of patients requiring further surgery. The aim of this
study was to investigate the frequency and time of occurrence of complications following
cranioplastic procedures in children and adults.
Material and Methods Data of children and adults who underwent cranioplasty between July 2010 and March
2018 were analyzed retrospectively. Clinical data, complications, and risk factors
regarding aseptic bone resorption (ABR) were evaluated including patient age, occurrence
of shunt-dependent hydrocephalus, and number of fragments in autologous bone flaps.
Results Severe traumatic brain injury (TBI) was the leading cause for DC among children (66.7%),
associated with a significantly higher number of fragments (p = 0.002). In the adult population, the most common cause was malignant infarction
(55.9%) followed by TBI (24.6%). Pediatric patients in our institution received autologous
bone flaps less frequently than adult patients (61.1% and 83.1%, respectively). Young
age and a higher number of fragments in autologous bone flaps were associated with
the occurrence of ABR. Children and adolescents showed significantly higher rates
of aseptic bone necrosis (p = 0.007) and revision cranioplasty (p = 0.036). Kaplan-Meier estimates were used to further analyze bone flap resorption
in children and adults, showing that revision surgery due to ABR was performed earlier
in children (p = 0.001, log-rank test).
Conclusion Pediatric patients demand specific care when cranioplasty is performed following
DC. We identified age as an independent risk factor. The higher number of fragments
appears to be a correlation due to the higher number of TBIs in children. Our data
indicate that young age is the most important risk factor for the development of ABR
as a frequent and early complication with a shorter revision-free time interval in
children. Consequently, the uncritical use of cryopreserved autologous bone flaps
should be questioned in this population.
Keywords
cranioplasty - children - adolescents - bone resorption - risk factors
