Immediate and Long-Term Outcomes of Autologous and Alloplastic Cranioplasty in Pediatric Population

Conventionally, alloplastic implants have been discouraged in pediatric cranioplasty due to concerns of infection and growth restriction. With the increasing development of patient-specific implants, this study compares the outcomes of pediatric cranioplasties using autologous grafts and alloplastic materials. A retrospective review was performed on all pediatric cranioplasties at a single institution between 2011 and 2024. The primary outcome measure was the conversion rate from autologous to alloplastic reconstruction. Secondary outcomes included assessment of age, sex, indication for surgery, defect size, location, operative time, medical history, and need for blood transfusion in cranioplasty groups. Over ∼13 years, 68 cranioplasties were identified in 57 patients. The mean patient age was 8.5 (range: 1.4-18.5). Twenty-nine cranioplasties were performed using autologous grafts (banked frozen bone flap or split thickness calvarial graft) and 39 used alloplastic implants, including titanium, polymethyl methacrylate, polyethylene titanium, and cadaveric allograft. The autologous cranioplasty group had a significantly greater complication rate (7/29), compared with the alloplastic group (3/39; P<0.05). The adjusted mean surface area defect was significantly greater in the alloplastic cranioplasty group, while no significant differences were observed in the location of the calvarial defect. When combined, the patients' age at the time of surgery was significantly higher in the cranioplasty group that had a complication compared with the cranioplasty group without any complications. The use of alloplastic implants in pediatric cranioplasties at our centre is not associated with a higher frequency of complications relative to autologous bone grafts.