Osteolyse nach Kranioplastik im Anschluss an eine dekompressive Hemikraniektomie bei Kindern

Decompressive hemicraniectomy (DHC) is a life-saving procedure, but data on its use in children is limited in the literature. Autologous cranioplasty is typically performed to reconstruct the calvarial defect once brain swelling has subsided. The two major causes of failure following autologous cranioplasty are bone flap resorption (BFR) and graft infection (GI). Here, we present the outcomes of autologous cranioplasty in our series of pediatric patients who underwent DHC.

A total of 39 children who underwent DHC followed by autologous cranioplasty were identified over a 15-year pediod. The following data were analyzed: demographics, clinical features, mortality, time to cranioplasty, failures associated with autologous cranioplasty, and the subsequent need for implantation of a 3D personalized skull implant (PSI).

Among the 39 children included in the study, median age of 11.67 years (range: 0–17.92 years), 24 (61.54%) were male. The most common indication for DHC was traumatic brain injury (TBI), accounting for 21/39 cases (54%). The overall mortality rate was 26.7% (10/39). The median time to autologous cranioplasty following DHC was 100 days (range: 17–216 days). The median last available follow-up period was 42 months (range: 5–176 months). A total of 5 patients (17.2%) developed osteolysis after a median of 15 months (range 9-159) post-cranioplasty. Of these, 4 cases were attributed to BFR, and 1 case was due to GI. Four of these patients required subsequent implantation of a 3D PSI. One patient, who had undergone bilateral DHC, developed BFR on both sides. In another patient, an autologous rib graft was implanted, which showed osteolysis after 159 months, necessitating revision surgery with a PSI. The median time to autologous cranioplasty in patients who did not develop osteolysis (N=24) was 102.5 days, compared to 93 days in those who developed osteolysis (N=5).

Autologous cranioplasty following DHC in pediatric patients is a generally effective procedure. No significant difference in the time to cranioplasty between those who developed osteolysis and those who did not was found.