Pediatric cranioplasty: lessons from a 1940s neurosurgical procedure☆

Abstract No clear consensus exists regarding the best material and technique for use in pediatric cranioplasty. The immature bone in pediatric patients poses several challenges, such as rapid growth, skull growth restriction, plate migration, and tissue erosion. We present a pediatric cranioplasty from the 1940s, and examine the characteristics of the plating and anchoring used. The patient suffered a skull fracture after falling from a swing in 1946 at age six, requiring cranioplasty. Sixty-seven years later, she noted drainage from the old incision site, requiring reoperation. During surgery, the skull appeared normally shaped, and the area under the plate exhibited complete bone growth. The plate was noted to have several innovative design features that contributed to this outcome, notably that the plate and its anchors were “semi-rigid”; the hardware was softer than surrounding bone and easily pliable, deforming to accommodate skull growth and prevent restriction. The structure of the plate was also such that it allowed growth of underlying bone tissue to close the defect. This case contains unique features that can foster discussion regarding plate design and surgical technique that might avoid traditional complications.