Characteristics and Clinical Significance of Skull Defect Restoration in Young Patients: A Single-center Report and Literature Review.

Abstract

Objective: The objective of this study is to observe cranial regeneration following cranial defects in young patients and analyze the factors influencing the regeneration process.

Methods: In this retrospective study, a comparative and analytical assessment was conducted on the clinical data of 2 distinct cohorts: the observation group comprised patients aged ≤22 years with a regenerated cranial area ≥4 cm2 following cranial defects, while the control group consisted of individuals with cranial defects persisting for over 1 year and a regenerated cranial area measuring <4 cm2. These patients had been admitted to our department from August 2008 to October 2022. In addition, an analysis was undertaken to discern the pertinent factors influencing the process of cranial regeneration.

Results: Among the 32 patients in the observation group, 9 patients developed complications after decompressive craniectomy (DC) (hereafter referred to as post-DC complications); all the patients in this group, except one, underwent cranioplasty. The control group consisted of 12 patients, all of whom had post-DC complications and underwent cranioplasty; among them, 4 patients with a coexisting complication of hydrocephalus also underwent ventriculoperitoneal shunting. Cranial regeneration was observed in all 23 patients who did not have post-DC complications and in 9 of the 21 patients with post-DC complications. The rate of cranial regeneration was lower in the group with post-DC complications than in the group without post-DC complications, and the observation time (the time from cranial defect to the completion of cranioplasty) was longer in patients in the group with post-DC complications than those in the group without post-DC complications.

Conclusion: Cranial bone regeneration can be achieved in young patients with cranial defects if factors favorable to cranial regeneration are effectively managed. These include preserving the dura mater, periosteum, and diploe during the surgery and maintaining good physical conditions postoperatively. The distribution pattern of the regenerated bones aligns with the shape of the flap. Post-DC complications represent adverse factors that can negatively affect cranial regeneration.