Introduction. Cranial reconstruction (CR) is a neurosurgical procedure performed to restore the cranial vault after a decompressive craniectomy. There are contrasting reports from the literature about the complications related to the use of heterologous materials for CR in the pediatric population. In this study, the authors we try to better define such rate of adverse events for autologous and heterologous materials
Material and method. A systematic review of articles published up to December 2021 was performed. Studies were included if they reported the specific use of cranioplasty materials following craniectomy in patients younger than 18 years of age, and had a minimum follow-up of at least 1 year.
Results. A total of 20 studies have been selected. A total of 544 cases were included, of which 422 cases (77.6 %) with heterologous materials and 122 cases (22.4%) with autologous bone. The mean average age was 9.5 years. PEEK and PMMA reported 29% and 33.3%, respectively of complications but only 3% and 5.6%, of surgical revision. PHA reported a rate of 11.9%. Titanium reported 9.2% complications and 4.1% of surgical revisions. Porous polyethylene had a complication rate of 36.4% and a revision rate of 0%.
Conclusion. There is still no perfect material for CR. it seems that heterologous materials are superior to autologous bone for CR is children and we may consider, whenever economical conditions will allow it, to use alloplastic material as first-line in small children
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