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Outcomes Of Pediatric Calvarial Reconstruction With Porous Polyethylene Implants: A Mid-Term Report
Liliana Camison, MD
Wei-Wei Lee, BS
Renata Maricevich, MD
Sanjay Naran, MD
Lorelei J. Grunwaldt, MD
Jesse A. Goldstein, MD
Joseph E. Losee, MD
University of Pittsburgh, Department of Plastic Surgery
2015-03-15
Presenter: Liliana Camison, MD
Affidavit:
I agree with all information and authorship in this abstract. This is original data and has not been published.
Director Name: Joseph E Losee, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Pediatric large-scale calvarial defects pose a reconstructive challenge. The replaced craniectomy bone flap usually undergoes resorption, and split-calvarial grafting might be unavailable in younger children. Porous polyethylene (PPE) is an alloplast manufactured to match defects through 3D-CT scans. We sought to analyze the outcomes of PPE cranioplasties in children.
Methods: A retrospective review of children undergoing PPE cranioplasties between 2007-2014 was performed. Detailed data on course and follow-up were extracted. Descriptive statistical analyses were performed to assess success.
Results: Twelve children (average 7.7 years; 2.4-16.5) underwent PPE cranioplasties. Causes were varied. Defects comprised at least 30% of the calvaria (8 unilateral/4 bifrontal). 77% of patients failed initial cranioplasty attempts; 53% had previous courses complicated by bone/shunt infections. At last follow-up, averaging 49 months, 11 patients had good contours and symmetry without any complications. One neurosurgical iatrogenic event led to implant removal 5 years postoperatively.
A subset analysis of 9 patients with the longest follow-up (average 5.2 years) showed that 8 followed ascending head growth curves, except for one with severe TBI sequelae. All 8 had symmetric skull expansion on exam and imaging, with only mild temporal hollowing. No revisions were required.
Conclusions: PPE cranioplasty appears to be a safe alternative for pediatric calvarial reconstruction in the setting of large defects, and despite previously complicated courses. All patients follow their head growth curves and preserve good results. The one case with questionable growth restriction could be attributable to TBI sequelae. However, this warrants careful consideration in children <4 years.
