What Is The Best Method Of Skull Reconstruction In A Child?
Q: Dr. Eppley, my son is 5 years old and has undergone a craniectomy of the right parietal skull bone which is quite large when he was 4 years old. We want to know which cranioplasty procedure would be best for him, bone cement or autologous bone transplant from the adjacent side of the skull? He is otherwise neurologically fine with no functional or developmental deficits.
A: To give a very specific answer as it relates to your son, I would need to know some more information about his defect including reviewing a CT scan and see pictures of him. But I can make some general comments about skull reconstruction in children. When you have large skull defects in young children, the reconstuction options are somewhat more limited because you really don’t have the ability to use a cranial bone graft. While a cranial bone graft, what you call an autologous bone transplant, can be done you essentially would be ‘robbing Peter to pay Paul’ do to speak. In children the skull is not think enough to harvest a split-thickness cranial graft. This using a cranial bone graft just creates the same problem you are trying to solve somewhere else. Thus one is forced to use a variety of synthetic methods for the skull reconstruction. These could include bone cements (resorbable and non-resorbable), metal meshes (one I wouldn’t do), and a assortment of synthetic implant material that are either preformed or custom-made from a CT scan. (e.g., HTR-PMI) There are advantages and disadvantages to all of these synthetic approaches and that needs to be discussed on an individual case basis.
Dr. Barry Eppley