Pediatric Cranioplasty in Ireland 2006 to 2023: An 18-Year Retrospective Review

Cranioplasty in the pediatric population presents unique challenges due to ongoing skull growth, variable bone quality, and material-specific risks. This study reviews an 18-year experience of pediatric cranioplasty at a national referral center, evaluating complication and revision rates across autologous and synthetic implant types. A retrospective chart review was performed for all patients aged younger than or equal to 16 years who underwent cranioplasty between 2006 and 2023. Data collected included demographics, implant material, storage method for autologous bone, defect characteristics, and postoperative outcomes. A total of 103 cranioplasties were performed in 94 patients, with a mean age of 10.3 years and mean defect size of 77.7 cm2. Autologous bone was used in 52.4% of cases, hydroxyapatite in 29.1%, titanium in 10.7%, and polyetheretherketone (PEEK)/patient‑specific implants (PSI) in 7.8%. Overall complication and revision rates were 11.7% and 9.7%, respectively. Autologous bone showed the highest resorption rate (11.1%), particularly in cryopreserved flaps. Hydroxyapatite demonstrated the lowest complication rate (6.7%) but was associated with pseudomeningocele formation. PEEK/PSI implants had favorable outcomes, with one infection in a patient with extensive prior surgical intervention. Titanium implants had low complication rates but were discontinued due to patient-reported morbidity, including cold sensitivity and soft-tissue discomfort. This large single-center series highlights the importance of tailored material selection in pediatric cranial reconstruction. Although autologous bone remains widely used, synthetic materials offer favorable complication profiles. Long-term, multicentre outcomes are required to determine optimal implant choice across age groups and defect sizes.