Pediatric Cranioplasty Using Particulate Calvarial Bone Graft

Background: Closure of calvarial defects in children is problematic because the supply of autologous bone is limited and alloplastic materials are not advocated. The authors previously showed that cranial particulate bone graft applied over the coronal gap during primary fronto-orbital advancement reduced the incidence of residual osseous defects. The purpose of this study was to determine the effectiveness of particulate bone graft for established calvarial defects. Methods: The authors analyzed consecutive children who had undergone cranioplasty with inlay particulate bone grafting between 1989 and 2007. Particulate bone was harvested from parietal calvaria or from the endocortex of the cranial elements using a hand-driven brace and bit. Patient records were reviewed for age at the time of cranioplasty, operative indication, size of defect, and length of follow-up. Outcome variables included persistent osseous defects, need for further cranioplasty, and complications. Results: Thirty-eight children had inlay particulate bone grafting at an average age of 8.0 years (range, 3 to 20 years). The average defect size was 66.5 cm2 (range, 5 to 250 cm2). Indications for inlay grafting were revision fronto-orbital advancement, bony gaps following primary cranial remodeling, congenital defects, trauma, and tumor. Mean follow-up was 6.1 years (range, 0.5 to 18 years). Three patients (7.9 percent) had small persistent osseous defects, and one (2.6 percent) required another cranioplasty. Conclusions: Inlay autologous cranial particulate bone graft effectively heals established cranial defects in children. Particulate bone graft can be harvested in infants and young children, does not require neurosurgical assistance, and has minimal morbidity.