Pediatric Cranioplasty

Q: Dr. Eppley, I am interested in a pediatric cranioplasty for my young sone. You stated that bone cement would be the best option for a younger patient. Why is this the preferred choice instead of an implant? If we did this for our son would he have any issues in the future? For example- could he play football and would physical roughness or a tumble off his bike, or any other mild head injury pose a health risk with the bone cement? Also you stated that we would have to go thru insurance with a predetermined level of approval. This could be difficult considering the doctors we have spoken to consider this to be a cosmetic issue. Could it be something we electively do for our son? I am just devastated that we blindly trusted his doctors and did not helmet him! I am heartbroken that my lack of action has left his head deformed. I know you can’t give an estimate without a proper consultation but I am serious and intend to be very aggressive about this before it could possibly effect my sons esteem and quality of life so could you give even a rough or general estimate so that I know where my family needs to be financially to even consider seeing you?

Thanks again for your time!

A: In young children with growing skulls, the use of hydroxyapatite cement seems the most biologically appropriate for a pediatric cranioplasty as the cement will integrate into the bone. (bone will actually grow over it and it will become incorporated into the bone as it grows) Thus both short and long-term there would be differences in the skull’s growth nor affect its structural integrity. A custom made skull implant in many ways is ‘simpler’ because it is reshaped this makes the surgery easier. But the long-term fate of such an implant on the skull’s growth is unknown as it has never been done to my knowledge. Whether it would affect the skull’s growth or would in any way affect the function of the skull bone is unknown. It may well be that it does not but there is no way to predict that up front.

Because of the cost of hydroxypatite cement, the need for a pediatric anesthesiologist and its performance in a hospital (in adults I simply do this in my surgery center), the cost of such surgery would be astronomically high and out of the economic reach of most families. For this reason every effort should be made to go through the insurance predetermination process. With insurance submission you never know what they will or will not approve. I have seen such cases go both ways. (approved vs. denied)

Dr. Barry Eppley

Indianapolis, Indiana