Repair of Cranial Bone Defects in Children Using Synthetic Hydroxyapatite Cranioplasty (CustomBone)

Abstract

In pediatric cases, the use of autologous bone tissue to repair cranial bone defects is often impossible. The synthetic hydroxyapatite bone substitute (CustomBone) can be a good alternative, especially in case of a large bone defect that has to be repaired. This study focuses on a pediatric series of 30 children who underwent cranioplasty with a CustomBone implant. Patient age ranged from 8 months to 16 years, with a mean age of 7 years and 8 months. The most common indication for cranioplasty was posttraumatic decompressive craniectomy. No complications were reported. Cosmetic results were satisfactory in every patient. Only 1 implant had to be changed after severe head trauma because of an epileptic seizure in the early postoperative period. In all patients, cerebral blood flow improved during the postoperative phase. Complete implant osteointegration is a long process because mean time to begin was 13 months (range, 3-22 months). Mean patient follow-up was 6.7 years. Successful prosthesis integration depends on the accuracy of the preoperative model. The minimum thickness of the implant (4 mm) represents a challenge in very young children, but we used it with success in this series. Moreover, high costs represent another limitation for its use. The CustomBone implant meets all necessary conditions for good clinical outcome: excellent protective properties, restoration of normal intracranial physiology, satisfactory cosmetic results, good integration in the autologous bone, and good resistance in case of trauma.