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A Survey of the ASCFS Membership: How Big is a "Critical" Cranial Defect, Should it be Repaired, and How?
Sanjay Naran, MD, Renata Maricevich, MD, Lilliana Camison, MD, Joseph Losee, MD, Jesse Goldstein, MD
Department of Plastic Surgery, University of Pittsburgh School of Medicine
2015-03-09
Presenter: Sanjay Naran, MD
Affidavit:
I attest that the project here in listed is the original work of the submitting resident.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Cranial defects are challenging to reconstruct in the pediatric population, where donor sites are often limited. Our goal was to better understand the risks of persistent cranial defects and the indications for reconstruction.
A multiple-choice survey was e-mailed to ASCFS members. Respondent demographics were obtained. Respondents were asked how many patients in their care have sustained intracranial injuries as a result of a persistent cranial defect; to specify the minimum size (diameter) above which they recommend reconstructing a cranial defect in patients <2, 2-6, 6-10, and >10 years of age; and how they would reconstruct them. Descriptive analysis was performed.
32 surgeons responded. 94% had completed a craniofacial fellowship. Average years in practice were 11.4 (range: 1-34). 84.4% were academic. Patients with intracranial injuries secondary to a persistent cranial defect averaged 0.47/respondent. Definition of "critical" defect diameter varied widely: <2yrs (8-50mm), 2-6yrs (10-60mm), 6-10yrs (10-70mm), and >10yrs (10-80mm). Split calvarial bone graft was the most popular choice for reconstruction in all age groups (p<0.05). Use of alloplastic materials was associated with increased patient age (p<0.05). Use of titanium was least popular (p<0.05).
An intracranial injury secondary to persistent cranial defects appears to be rare. However, not only does the indication to operate on such "critical" defects vary widely with respondents, there is wide discrepancy in the definition of a "critical" sized cranial defect. We highlight that there is no consensus of what size warrants a "critical" defect of the cranium, or if such a defect should even be reconstructed.
