Safety and Efficacy of Cranioplasty Using Autologous Calvarial Graft in Large Cranial Defects: A 10-year Experience
Kathleen N. Johnson, Chenyu Liu, Esperanza Mantilla-Rivas*, Monica Manrique, Austin Tapp, Skyler Richardson, Albert Oh, Gary F. Rogers
Plastic and Reconstructive Surgery, Children's National Hospital, Washington,
Large cranial defects in pediatric patients come with difficult, unique challenges for craniofacial surgeons (1,2). Cranioplasty techniques using autologous calvarial grafts include split-thickness, particulate, and exchange cranioplasty (2,3). This study aims to describe the authors' 10-year experience with these techniques including immediate postoperative course, and safety and efficacy of the procedure.
A retrospective study on patients receiving a cranioplasty with autologous calvarial grafts at our institution between 2012-2022 was performed. Size of the cranial defect on CT was measured using the baffle planner module on 3D Slicer (4,5). Safety was measured by transfusion rate, pain management, and complication rate. Efficacy was assessed through rate of resorption and redo-cranioplasty.
Twenty-one patients were included. Average age was 9.1 ± 4.5 years. The mean defect size was 158.0 ±116.4 (range 15.9-373.2) cm2. Indications for cranioplasty included: revision (16.6%), trauma (11.1%), mass (7.4%), and infection (3.7%). Mean operative time was 4.8 ± 1.5 hours. Mean blood loss was 212.5 ± 75.9 cc with nearly half of patients requiring intraoperative transfusion. Defects were repaired using a combination of split-thickness, particulate, and exchange in 57.1%, split-thickness and particulate in 23.8%, exchange in 14.3%, and particulate only in 4.8%. Mean length of stay (LOS) was 4 ± 1.0 days. Average FLACC score for LOS was 1.7 ± 1.8. Average morphine equivalents for LOS was 2.0 ± 5.5 mme/kg. Average follow-up was 13.9 months. There were no complications or resorptions reported, however, one patient required a reoperation due to recurrence of fibrous dysplastic lesions.
Overall, we did not encounter any complications or resorptions on an average 14-month postoperative follow-up. We found autologous calvarial cranioplasty including split-thickness, particulate, and exchange graft techniques to be safe and efficacious to perform in children with large cranial defects.
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