{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:32:05Z","timestamp":1787164325186,"version":"build-2736575974"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T00:00:00Z","timestamp":1755302400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T00:00:00Z","timestamp":1755302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Bonn"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric cranioplasty following decompressive craniectomy is associated with high complication rates, particularly bone resorption and infection. Unlike adult populations, children face unique anatomical and physiological challenges, and the lack of viable alternatives to autologous bone graft further complicates outcomes. This meta-analysis aims to evaluate the current state of pediatric cranioplasty, identifying key predictors of bone resorption and infection, and assessing outcomes to guide future clinical improvements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was conducted in MEDLINE\/PubMed and Web of Knowledge using combinations of the terms \"cranioplasty,\" \"pediatric,\" \"children,\" and \"decompressive craniectomy.\" Studies were included if they reported quantitative data on outcomes in pediatric populations. Risk of bias were assessed using the ROBINS-I tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven retrospective case series encompassing 594 patients were analysed. The average age of patients was 8.4\u00a0years, with a mean follow-up of 37.8\u00a0months. The mean time from craniectomy to cranioplasty was 12.5\u00a0weeks. Autologous bone graft was used in 77.6% of cases. The rate of bone resorption requiring reoperation approached 30%, and infection occurred in approximately 10% of patients. Delayed cranioplasty (&gt;\u20096\u00a0weeks), large skull defect area, underlying cerebral contusion, and comminuted fractures significantly predicted bone graft resorption. The use of ventriculoperitoneal shunts, cranial implants, and non-titanium fixation materials were associated with higher infection and resorption rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pediatric cranioplasty carries unacceptably high complication rates for an elective procedure. Early intervention and the use of titanium fixation may reduce the burden of reoperation. Further prospective studies are necessary to establish standardized surgical protocols and explore alternative materials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-025-06637-x","type":"journal-article","created":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T01:09:56Z","timestamp":1755306596000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond decompression: predictors of cranioplasty failure in pediatric patients \u2013 a meta-analysis"],"prefix":"10.1007","volume":"167","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2269-5707","authenticated-orcid":false,"given":"Ehab","family":"Shabo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6mer Can","family":"Yildiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Wispel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Heimann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah-Marie","family":"Gallert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartmut","family":"Vatter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevgi","family":"Sarikaya-Seiwert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,16]]},"reference":[{"issue":"3","key":"6637_CR1","doi-asserted-by":"publisher","first-page":"433e","DOI":"10.1097\/PRS.0000000000005933","volume":"144","author":"A Abu-Ghname","year":"2019","unstructured":"Abu-Ghname A et al (2019) Outcomes and complications of pediatric cranioplasty: a systematic review. Plast Reconstr Surg 144(3):433e\u2013443e","journal-title":"Plast Reconstr Surg"},{"key":"6637_CR2","doi-asserted-by":"publisher","first-page":"e479","DOI":"10.1016\/j.wneu.2019.08.106","volume":"132","author":"M Behbahani","year":"2019","unstructured":"Behbahani M et al (2019) Cranioplasty in infants less than 24 months of age: a retrospective case review of pitfalls, outcomes, and complications. World Neurosurg 132:e479\u2013e486","journal-title":"World Neurosurg"},{"issue":"1","key":"6637_CR3","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1007\/s00701-024-06277-7","volume":"166","author":"N Beucler","year":"2024","unstructured":"Beucler N (2024) Indications and scientific support for supratentorial unilateral decompressive craniectomy for different subgroups of patients: a scoping review. Acta Neurochir (Wien) 166(1):388","journal-title":"Acta Neurochir (Wien)"},{"issue":"5","key":"6637_CR4","doi-asserted-by":"publisher","first-page":"526","DOI":"10.3171\/2013.1.PEDS12483","volume":"11","author":"CA Bowers","year":"2013","unstructured":"Bowers CA et al (2013) Risk factors and rates of bone flap resorption in pediatric patients after decompressive craniectomy for traumatic brain injury. J Neurosurg Pediatr 11(5):526\u2013532","journal-title":"J Neurosurg Pediatr"},{"issue":"2","key":"6637_CR5","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.ncl.2021.11.009","volume":"40","author":"GJ Cannarsa","year":"2022","unstructured":"Cannarsa GJ, Simard JM (2022) Decompressive craniectomy for stroke: who, when, and how. Neurol Clin 40(2):321\u2013336","journal-title":"Neurol Clin"},{"issue":"10","key":"6637_CR6","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1016\/j.jocn.2007.09.022","volume":"15","author":"YK Cheng","year":"2008","unstructured":"Cheng YK et al (2008) Factors affecting graft infection after cranioplasty. J Clin Neurosci 15(10):1115\u20131119","journal-title":"J Clin Neurosci"},{"issue":"1","key":"6637_CR7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.13004\/kjnt.2017.13.1.9","volume":"13","author":"YJ Cho","year":"2017","unstructured":"Cho YJ, Kang SH (2017) Review of cranioplasty after decompressive craniectomy. Korean J Neurotrauma 13(1):9\u201314","journal-title":"Korean J Neurotrauma"},{"key":"6637_CR8","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.wneu.2016.04.115","volume":"92","author":"B Daou","year":"2016","unstructured":"Daou B et al (2016) Low incidence of bone flap resorption after native bone cranioplasty in adults. World Neurosurg 92:89\u201394","journal-title":"World Neurosurg"},{"key":"6637_CR9","doi-asserted-by":"crossref","unstructured":"Grant GA et al (2004) Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 100(2 Suppl Pediatrics):163\u20138","DOI":"10.3171\/ped.2004.100.2.0163"},{"issue":"9","key":"6637_CR10","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1007\/s00381-019-04165-5","volume":"35","author":"P Frassanito","year":"2019","unstructured":"Frassanito P (2019) Cranioplasty in children: time for a paradigm shift. Childs Nerv Syst 35(9):1457\u20131458","journal-title":"Childs Nerv Syst"},{"issue":"10","key":"6637_CR11","doi-asserted-by":"publisher","first-page":"1759","DOI":"10.1007\/s00381-017-3541-8","volume":"33","author":"P Frassanito","year":"2017","unstructured":"Frassanito P et al (2017) Problems of reconstructive cranioplasty after traumatic brain injury in children. Childs Nerv Syst 33(10):1759\u20131768","journal-title":"Childs Nerv Syst"},{"issue":"6","key":"6637_CR12","first-page":"375","volume":"43","author":"R Gruber","year":"1988","unstructured":"Gruber R, Peter R, Hora J (1988) The prognosis of cranioplasty following large craniectomy in children. Z Kinderchir 43(6):375\u2013383","journal-title":"Z Kinderchir"},{"key":"6637_CR13","doi-asserted-by":"crossref","unstructured":"Iwama T et al (2003) The use of frozen autogenous bone flaps in delayed cranioplasty revisited. Neurosurg 52(3):591\u20136; discussion 595\u20136","DOI":"10.1227\/01.NEU.0000047891.86938.46"},{"issue":"9","key":"6637_CR14","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1007\/s00381-018-4025-1","volume":"35","author":"VM Klieverik","year":"2019","unstructured":"Klieverik VM et al (2019) Cranioplasty after craniectomy in pediatric patients-a systematic review. Childs Nerv Syst 35(9):1481\u20131490","journal-title":"Childs Nerv Syst"},{"issue":"11","key":"6637_CR15","doi-asserted-by":"publisher","first-page":"3757","DOI":"10.1007\/s00381-024-06513-6","volume":"40","author":"SK Konar","year":"2024","unstructured":"Konar SK et al (2024) Decompressive craniectomy in children: indications and outcome from a tertiary centre. Childs Nerv Syst 40(11):3757\u20133764","journal-title":"Childs Nerv Syst"},{"issue":"1","key":"6637_CR16","doi-asserted-by":"publisher","first-page":"10","DOI":"10.13004\/kjnt.2014.10.1.10","volume":"10","author":"SH Lee","year":"2014","unstructured":"Lee SH et al (2014) Resorption of autogenous bone graft in cranioplasty: resorption and reintegration failure. Korean J Neurotrauma 10(1):10\u201314","journal-title":"Korean J Neurotrauma"},{"key":"6637_CR17","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.wneu.2018.05.009","volume":"116","author":"JG Malcolm","year":"2018","unstructured":"Malcolm JG et al (2018) Autologous cranioplasty is associated with increased reoperation rate: a systematic review and meta-analysis. World Neurosurg 116:60\u201368","journal-title":"World Neurosurg"},{"key":"6637_CR18","doi-asserted-by":"publisher","first-page":"e56","DOI":"10.1016\/j.wneu.2019.04.215","volume":"129","author":"M Manfiotto","year":"2019","unstructured":"Manfiotto M et al (2019) Decompressive craniectomy in children with severe traumatic brain injury: a multicenter retrospective study and literature review. World Neurosurg 129:e56\u2013e62","journal-title":"World Neurosurg"},{"issue":"4","key":"6637_CR19","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1007\/s00701-014-2021-0","volume":"156","author":"KD Martin","year":"2014","unstructured":"Martin KD et al (2014) Autologous bone flap cranioplasty following decompressive craniectomy is combined with a high complication rate in pediatric traumatic brain injury patients. Acta Neurochir (Wien) 156(4):813\u2013824","journal-title":"Acta Neurochir (Wien)"},{"key":"6637_CR20","doi-asserted-by":"crossref","unstructured":"Matsuno A et al (2006)\u00a0Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir (Wien) 148(5):535\u201340; discussion 540","DOI":"10.1007\/s00701-006-0740-6"},{"key":"6637_CR21","doi-asserted-by":"publisher","first-page":"864385","DOI":"10.3389\/fsurg.2022.864385","volume":"9","author":"H Mee","year":"2022","unstructured":"Mee H et al (2022) Cranioplasty: a multidisciplinary approach. Front Surg 9:864385","journal-title":"Front Surg"},{"issue":"2","key":"6637_CR22","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1097\/00001665-200303000-00003","volume":"14","author":"A Moreira-Gonzalez","year":"2003","unstructured":"Moreira-Gonzalez A et al (2003) Clinical outcome in cranioplasty: critical review in long-term follow-up. J Craniofac Surg 14(2):144\u2013153","journal-title":"J Craniofac Surg"},{"issue":"5S Suppl 4","key":"6637_CR23","doi-asserted-by":"publisher","first-page":"S289","DOI":"10.1097\/SAP.0000000000001801","volume":"82","author":"JD Oliver","year":"2019","unstructured":"Oliver JD et al (2019) Alloplastic cranioplasty reconstruction: a systematic review comparing outcomes with titanium mesh, polymethyl methacrylate, polyether ether ketone, and Norian implants in 3591 adult patients. Ann Plast Surg 82(5S Suppl 4):S289\u2013S294","journal-title":"Ann Plast Surg"},{"issue":"4","key":"6637_CR24","doi-asserted-by":"publisher","first-page":"268","DOI":"10.3171\/2012.6.PEDS1268","volume":"10","author":"MP Piedra","year":"2012","unstructured":"Piedra MP et al (2012) Optimal timing of autologous cranioplasty after decompressive craniectomy in children. J Neurosurg Pediatr 10(4):268\u2013272","journal-title":"J Neurosurg Pediatr"},{"issue":"3","key":"6637_CR25","doi-asserted-by":"publisher","first-page":"225","DOI":"10.3171\/2018.3.PEDS17234","volume":"22","author":"BG Rocque","year":"2018","unstructured":"Rocque BG et al (2018) Complications following pediatric cranioplasty after decompressive craniectomy: a multicenter retrospective study. J Neurosurg Pediatr 22(3):225\u2013232","journal-title":"J Neurosurg Pediatr"},{"key":"6637_CR26","doi-asserted-by":"publisher","first-page":"e561","DOI":"10.1016\/j.wneu.2022.08.043","volume":"167","author":"S Safi","year":"2022","unstructured":"Safi S et al (2022) Predictors of clinical outcomes in autologous cranioplasty. World Neurosurg 167:e561\u2013e566","journal-title":"World Neurosurg"},{"issue":"9","key":"6637_CR27","doi-asserted-by":"publisher","first-page":"2761","DOI":"10.1007\/s00381-024-06445-1","volume":"40","author":"S Sarikaya-Seiwert","year":"2024","unstructured":"Sarikaya-Seiwert S et al (2024) Decompressive craniotomy in split-technique (DCST) for TBI in infants: introducing a new surgical technique to prevent long-term complications. Childs Nerv Syst 40(9):2761\u20132768","journal-title":"Childs Nerv Syst"},{"key":"6637_CR28","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","volume":"355","author":"JA Sterne","year":"2016","unstructured":"Sterne JA et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919","journal-title":"BMJ"},{"issue":"3","key":"6637_CR29","doi-asserted-by":"publisher","first-page":"196","DOI":"10.2176\/nmc.29.196","volume":"29","author":"K Tokoro","year":"1989","unstructured":"Tokoro K, Chiba Y, Tsubone K (1989) Late infection after cranioplasty\u2013review of 14 cases. Neurol Med Chir (Tokyo) 29(3):196\u2013201","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"2","key":"6637_CR30","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1159\/000452808","volume":"52","author":"M Waqas","year":"2017","unstructured":"Waqas M et al (2017) Cranioplasty after craniectomy in a pediatric population: single-center experience from a developing country. Pediatr Neurosurg 52(2):77\u201379","journal-title":"Pediatr Neurosurg"},{"issue":"7","key":"6637_CR31","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1016\/j.jcms.2016.03.010","volume":"44","author":"L Williams","year":"2016","unstructured":"Williams L, Fan K, Bentley R (2016) Titanium cranioplasty in children and adolescents. J Craniomaxillofac Surg 44(7):789\u2013794","journal-title":"J Craniomaxillofac Surg"},{"issue":"4","key":"6637_CR32","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1159\/000524874","volume":"57","author":"I Zaed","year":"2022","unstructured":"Zaed I et al (2022) Prevalence of postoperative complications of autologous and heterologous cranioplasty in the pediatric population: a systematic review of the literature. Pediatr Neurosurg 57(4):238\u2013244","journal-title":"Pediatr Neurosurg"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06637-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06637-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06637-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T14:44:23Z","timestamp":1757429063000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06637-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,16]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6637"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06637-x","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,16]]},"assertion":[{"value":"7 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"In accordance with institutional and national guidelines, ethical approval was waived as the study constitutes a meta-analysis and did not involve human participants or animal experimentation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate declarations"}},{"value":"All authors agreed to the publication of the manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}},{"value":"Not applicable, not registered.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Registration and protocol"}},{"value":"The Manuscript is not under consideration for publication anywhere.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Current state"}},{"value":"The authors declare no competing interests.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"222"}}