CRANIOPLASTIES FOR CONGENITAL AND ACQUIRED SKULL DEFECTS IN CHILDREN - COMPARISON OF NEW CONCEPTS WITH CONVENTIONAL METHODS

From 1974 to 1992 fifty-two patients with congenital or acquired skull defects were operated at the Department of Pediatric Surgery of the U niversity Children's Hospital of Zurich. By 1988, in 26 patients conve ntional methods with PMMA (polymethyl methacrylate) plasties or rib pl asties were performed. After 1988, in 26 patients skull reconstruction was done by skull splitting, application of lyophilized bone or carti lage or a combination of both. In the latter period, stabilization and fixation was always provided by biodegradable screws and bands. The r esults of the different techniques were compared in a retrospective fa shion. PMMA plasties provided immediately full stability and good cosm etic results. Another advantage was their availability. In one patient (= 4.8 %), a wound infection required the removal of the plasty. In t wo other patients (9.5 %), an increasing mobility of the plasty could be observed during skull growth. Rib plasties were not satisfying. Sku ll splitting or reconstruction with lyophilized bone or cartilage show ed good results with a stable integration within 3-4 months. In one pa tient (4 %), a superficial wound infection occurred, but it did not af fect the plasty. From the present study, we conclude that skull splitt ing or the reconstruction of skull continuity by means of lyophilized bone or cartilage with fixation through biodegradable screws and bands are the methods of first choice in children, because they are fully i ntegrated, avoid foreign material and might have a slightly lower risk of infection. In addition, removal of the implants may be avoided. Al though the long-term run is not known so far, growth may be unaffected , but continuous observation with CT or MRI scans, which are not distu rbed by the plasties, are warranted.