Article
The ugly side of the coin – cranioplasty after decompressive craniectomy in paediatric population – a meta-analysis
Die andere Seite der Medaille – Kranioplastik nach dekompressiver Kraniektomie bei pädiatrischer Population – eine Meta-Analyse
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Authors
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Ömer Can Yildiz
- Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
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Johannes Wach
- Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
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Mohammed Banat
- Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
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Hartmut Vatter
- Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
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Hannes Haberl
- Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
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Sevgi Sarikaya-Seiwert
- Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Contrary to the adult population, cranioplasty after decompressive craniectomy in pediatric population is still carrying the weight of unsolved problems, mainly due to the obvious lack of alternative materials replacing the autologous bone, which high rate of resorption may sometimes turn it to a liability. The purpose of our meta-analysis was to reflect the current state of affairs to open the door to improvements.
Methods: A systematic search wasdone in MEDLINE and Web of Knowledge databases for publications regarding the cranioplasty after DC in pediatric population, with the keywords cranioplasty, and “pediatric” or “children” along with any combinations of the words “decompression”, “decompressive” or “craniectomy”. The list was supplemented by reviewing the bibliographies of selected papers. Individual case reports as well as studies not providing quantitative data were excluded. In the end 7 retrospective case series were analysed. Obtained data included demographics, clinic at presentation, treatment protocols and outcome.
Results: 610 patients underwent cranioplasty after DC. Mean age was 8,35 years. Postoperatively 49 infections were seen leading to a re-surgery (8,03%). Out of 472 autologous cranioplasties, 138 had to be removed due to osteolysis (29,23%). In a study osteolysis was found to be most dependent on the age of the patient, with younger patients at higher risk for resorption, although this could not be checked due to the nature of the data on other studies. It was also interesting to note that a study showed an underlying contusion and the presence of a comminuted skull fracture were independent risk factors for bone flap resorption, although this was not analysed in other studies.
Conclusion: Cranioplasty after decompressive craniectomy in pediatric population is a procedure prone to complications. Utmost care must be taken during the planning and performing the operation. Moreover, further studies are needed for finding ways to contain the complication in acceptable levels.
