Cranioplasties for Congenital and Acquired Skull Defects in Children - Comparison of New Concepts with Conventional Methods

Abstract

From 1974 to 1992 fifty-two patients with congenital or acquired skull defects were operated at the Department of Pediatric Surgery of the University Children's Hospital of Zurich. By 1988, in 26 patients conventional methods with PMMA (polymethyl methacrylate) plasties or rib plasties were performed. After 1988, in 26 patients skull reconstruction was done by skull splitting, application of lyophilized bone or cartilage or a combination of both. In the latter period, stabilization and fixation was always provided by biodegradable screws and bands. The results of the different techniques were compared in a retrospective fashion. PMMA plasties provided immediately full stability and good cosmetic results. Another advantage was their availability. In one patient (= 4.8 %), a wound infection required the removal of the plasty. In two other patients (9.5 %), an increasing mobility of the plasty could be observed during skull growth. Rib plasties were not satisfying. Skull splitting or reconstruction with lyophilized bone or cartilage showed good results with a stable integration within 3-4 months. In one patient (4 %), a superficial wound infection occurred, but it did not affect the plasty. From the present study, we conclude that skull splitting or the reconstruction of skull continuity by means of lyophilized bone or cartilage with fixation through biodegradable screws and bands are the methods of first choice in children, because they are fully integrated, avoid foreign material and might have a slightly lower risk of infection. In addition, removal of the implants may be avoided. Although the long-term run is not known so far, growth may be unaffected, but continuous observation with CT or MRI scans, which are not disturbed by the plasties, are warranted.

Zusammenfassung

Zwischen 1974-1992 wurden an der Kinderchirurgischen Klinik der Universität Zürich 52 Kinder wegen kongenitaler oder erworbener Schädeldefekte operiert. Die bis 1988 angewandten konventionellen Methoden mit PMMA (Polymethylmethacrylat) oder Rippen (26 Fälle) wurden mit den nach 1988 verwendeten Techniken (26 Fälle) - wie "skull Splitting" oder Plastiken mit lyophilisiertem Bankknochen/knorpel unter ausschließlicher Verwendung von biodegradablen Implantaten zur Fixation - retrospektiv verglichen. Die PMMA-Plastiken ergaben bei sofortiger Stabilität ein gutes kosmetisches Resultat und waren jederzeit verfügbar; bei einem Patienten (4,8 %) führte ein Infekt zur Entfernung der Plastik. Zwei weitere Patienten (9,5 %) zeigten eine zunehmende Instabilität im Laufe der Jahre. Die Rippenplastiken waren bezüglich Kosmetik und Stabilität unbefriedigend. - Die neuen Techniken zeigten sehr schöne Resultate mit einer stabilen Einheilung nach 3-4 Monaten, während das Spendeareal in 3-6 Monaten abheilte. Aus der vorliegenden Studie schließen wir, daß Kranioplastiken, welche Fremdmaterial vermeiden, auch bei Kindern die Methode der Wahl darstellen, weil sie stabil einheilen, spätere Materialentfernungen vermeiden und langfristig wahrscheinlich eine kleinere Infektionsrate aufweisen.

Key words

Skull defect - Cranioplasties - Skull splitting - Lyophilized bone/cartilage - Biodegradable implants

Schlüsselwörter

Schädeldefekt - Kranioplastiken - Skull Splitting - Lyophilisierter Knochen/Knorpel - Biodegradable Implantate