Why a hydroxyapatite cranioplasty can be used to repair a cranial bone defect in children: Experience of 19 cases

Introduction. - The use of an autologous bone graft to repair a cranial bone defect is sometimes impossible in pediatric cases. CUSTOMBONE made with hydroxyapatite is a good alternative in these indications for neurosurgeons. Material and methods. - We present a pediatric series of 19 children who benefited from a cranioplasty using CUSTOMBONE. Their ages ranged between 8 months and 13 years with a mean of 6 years and 2 months. The most frequent indication was a cranioplasty after a post-traumatic decompressive craniectomy. Results. No complications were reported. Cosmetic outcome was satisfactory in all patients. Only one plasty needed to be changed after a severe head trauma during the postoperative period. The assessment of cerebral blood flow was improved in all patients postoperatively. Complete ossification of the plasty is a long process. The mean time for the ossification to begin was 13 months (range: 3-22 months). The mean follow-up was 2.7 years. Discussion. - The excellent integration of the prosthesis is related to the accuracy of the reconstruction of the preoperative model. The minimum thickness of the plasty (4 mm) could represent a challenge in very young children. One limitation is the cost, which remains high. Conclusion. - CUSTOMBONE met the criteria of protection and restoration of the normal intracranial physiology with good cosmetic results, which are necessary qualities for excellent clinical outcome. (C) 2016 Published by Elsevier Masson SAS.