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. 2022 Sep 9:13:406.
doi: 10.25259/SNI_1204_2021. eCollection 2022.

Comparison of autograft and implant cranioplasty in pediatrics: A meta-analysis

Dirga Rachmad Aprianto  1 , Muhammad Arifin Parenrengi  1 , Budi Utomo  2 , Asra Al Fauzi  1 , Eko Agus Subagio  1 , Ahmad Suryawan  3
Affiliations

Comparison of autograft and implant cranioplasty in pediatrics: A meta-analysis

Dirga Rachmad Aprianto et al. Surg Neurol Int. .

Abstract

Background: Cranioplasty in pediatrics is quite challenging and intricated. The ideal material for it is still debatable until now due to the limited study comparing autologous and implant grafts. This meta-analytic study was conducted to evaluate the risk of infection and revision in pediatric patients after autograft and implant cranioplasty.

Methods: A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A thorough literature search was conducted on PubMed, Cochrane, Scopus, and ScienceDirect database. Articles published from 2000 to 2021 were selected systematically using PRISMA based on the predetermined eligibility criteria. The relevant data were, then, analyzed and discussed.

Results: A total of four publications investigating the outcome of autograft and implant cranioplasty were included and reviewed. Postoperative infection and revision rate after 126 cranioplasty procedures (both autograft or implant) from 119 patients below 21 years during time frame of study were analyzed. This meta-analysis study showed that the rate of infection and revision after cranioplasty were not different between the autograft and implant groups.

Conclusion: Autograft and implant cranioplasty have no significant difference in postoperatively infection and revision rate. This study showed that cranioplasty using implant is a plausible option in pediatric patients with cranial defects, depending on the patients' condition due to similar outcome with autograft cranioplasty. Further studies with larger population and more specific details are necessary to determine the comparison of autograft and implant material in cranioplasty procedure.

Keywords: Autograft cranioplasty; Implant cranioplasty; Infection; Revision.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Flowchart of the searched literature.
Figure 2:
Figure 2:
Risk assessment bias. The risk assessment of bias used ROBINS-I for nonrandomized studies in each study (above) and the proportion of risk assessment results for bias using ROBINS-I for nonrandomized studies (below).
Figure 3:
Figure 3:
Analysis of the infection risk ratio of the autograft and implant groups. The risk of infection was not different in the autograft and implant groups. The results of the calculation of heterogeneity showed a very low number (RR = 1.26; 95% CI 0.21–7.46; P = 0.80).
Figure 4:
Figure 4:
Analysis of infection risk ratio in full-thickness autograft and implant groups. The risk of infection was not different in the full-thickness autograft with implant group. Very low heterogeneity results (RR = 1.45; 95% CI 0.25–8.53; P = 0.68; I2 = 0%).
Figure 5:
Figure 5:
Analysis of the risk ratio for the need for revision of the autograft and implant groups. The need for revision in the autograft group with implants was not much different. Very low heterogeneity results (RR = 2.08; 95% CI 0.83–5.25; P = 0.12; I2 = 0%).
Figure 6:
Figure 6:
Funnel plot for the analysis of need of revision between the autograft and implant cranioplasty. The “O” referring to the included studies for the analysis of need of revision between the autograft and implant cranioplasty subgroup as the forrest plot [Figure 5].
Figure 7:
Figure 7:
Analysis of the risk ratio requirement for revision of the full-thickness autograft and implant groups. The risk of needing a revision was not much different in the two groups where this result was not statistically significant. The calculation results show a very low heterogeneity (RR = 1.89; 95% CI 0.66e–5.46; P = 0.24; I2 = 0%).
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