Paediatric cranioplasty—Experience from a Singapore children’s hospital

Cranioplasty is a common neurosurgical procedure. Nonetheless, cranioplasty in the paediatric population pose a set of unique challenges owing to their developing craniums. We conducted a single institution, retrospective study of children that underwent cranioplasty; and corroborated our clinical outcomes with current literature. Data was statistically analysed to assess for factors associated with implant complications that required interval intervention. Thirty-two patients were recruited for the study from 01 January 2001 to 31 December 2021. Mean age was 7.9 years. For the cranial implants, there were 16 autologous (43.2%), 7 acrylic (18.9%), 5 titanium mesh (13.5%) and 4 PEEK (10.8%) grafts. Aetiologies for the skull defect include head injury (n = 22; 68.8%), neoplasm (n = 4; 12.5%), spontaneous intracranial haemorrhage (n = 3; 9.4%) and infection (n = 3; 9.4%). Eight patients (25%) required another surgery due to implant-related complications. Here, 3 patients had their implants removed due to infection (6.3%) and extrusion (3.1%); 4 had bone resorption of their autologous grafts (12.5%): and 1 patient (3.1%) had a postoperative acute extradural haematoma. A subgroup analysis was performed for patients (n = 16) with autologous skull implants. We observed that autologous bone cranioplasty at more than 6 weeks post-decompression was associated with higher rates of bone graft resorption (p = 0.008). The mean time for this group of patients to undergo a second surgery was 29.1 months. Overall, our results concur with the difficulties reported in previous publications and highlight the need for long-term followup to monitor for implant-related complications.