What Is The Best Method Of Skull Reconstruction In Children?

Q: Dr. Eppley, my three year-old son has an 8 x 10 cm parieto-occipital defect after a craniectomy. I know there are numerous methods of skull reconstruction such as bone cements, bone grafts and computer-generated implants. Is the computer-generated implant the best method?

I also have few more queries:

How safe is bone cement in the long run? What are the recovery rate and chances of infection post operation and also down the line, does the patient has to face any risks or infections? Since he is a growing child, his skull would grow, how would that be addressed? 

One of the neurosurgeons here suggested a autogenous bone graft using the bone from adjacent skull and slicing it laterally and then placing back the resultant two bone grafts each on the donor site and on the defect. How would that fare actually? I am worried regarding this process .

Another suggestion is to use rib grafts. The doctor here said its quite painful. What is your thought on this?

One more suggestion was something called “Osteosynth”….to place a scaffold over the defect and then place the patients bone on that, compelling the nearby bone cells to reach out for each other and then grow. Do you have any inputs on this?

A: In answer to your questions:

1) Computer-generated implants for cranial reconstruction is the best method when one’s bone is not available.

2) Bone cement is very safe and will work well, if it is placed properly into the defect and does not get displaced. As I mentioned in my last e-mail, you can not just put bone cement by itself in the cranial defect…that will not work. Any type or reconstruction will grow as the skull develops and is not a problem.

3) Your son is too young to try and split his cranial bone flap. It is too thin. That will not work. It is usually not possible to split cranial bone into two complete pieces until one is 10 or 12 years of age.

4) While you can harvest rib grafts, it will take at least 3 or 4 ribs to reconstruct the defect. That is too many ribs to take in a young child.

5) Osteosynth is just one of many resorbable bone substitute materials. Like the bone cements, it must be stabilized into the defect with little guarantee that it will regenerate real bone. If it does not, and it likely will not, then the defect will return. For smaller bone defects this may be an option, but not for one of your son’s size.

Dr. Barry Eppley

Indianapolis, Indiana