gms | German Medical Science

Objective: Cranioplasty is a common neurosurgical intervention following decompressive craniectomy, that is associated with high complication rates. Especially bone flap resorption leads to a considerable number of patients requiring further surgery. Aim of this study was to investigate the frequency and time of occurrence of complications following autologous cranioplastic procedures in children and adults.

Methods: Data of children and adults who underwent cranioplasty between 07/10 and 04/16 was analyzed retrospectively. Clinical data, complications and risk factors regarding aseptic bone resorption were evaluated including patients’ age, the occurrence of shunt-dependent hydrocephalus and the number of fragments in autologous bone flaps.

Results: During the observed period, 16 children and 88 adult patients underwent cranioplastic surgery. Severe traumatic brain injury (TBI) was the leading cause for decompressive craniectomy among children (75.0%), associated with a significantly higher number of fragments (p= 0.002). In the adult population, the most common cause was malignant infarction (50.0%) followed by TBI (26.1%). Pediatric patients in our institution received autologous bone flaps less frequently than adult patients (68.8 and 89.9%, respectively). Young age and a higher number of fragments in autologous bone flaps were associated with the occurrence of aseptic bone resorption. Children and adolescents showed significantly higher rates of aseptic bone necrosis (p= 0.012) and revision cranioplasty (p= 0.016). Kaplan Meier estimates (Figure 1 [Fig. 1]) 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 decompressive craniectomy. We identified age as an independent risk factor while the higher number of fragments appears to be a correlation due to the higher number of TBI in children. Our data indicate that young age is the most important risk factor for the development of aseptic bone flap resorption 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.