Factors and Rates of Bone Flap Resorption in Pediatric Patients After Craniectomy for Traumatic Brain Injury

Christian Andrew Bowers, MD1, D.A. Hertzler1, J. Riva-Cambrin1, M.L. Walker1

1Salt Lake City, UT United States

Keywords: children, traumatic brain injury, craniectomy, cranioplasty, outcome

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     We found that 50.9% (27/53) of our sample patients experienced BFR. The average sample age was 6.25 years (+/- 4.73 yrs).
     We performed a retrospective chart cohort review for long-term survivors that underwent DC for severe TBI from 1996 to 2010. We looked at the following variables: Age, sex, mechanism, GCS, Rotterdam score, comminuted skull fracture (SF), post-traumatic hydrocephalus (PTH), infection, time to AC and/or BFR. We analyzed these variables in a bivariate statistical fashion and we used a multivariate logistic regression model for the significant, and near-significant variables.
     The mean time to AC was 2.06 months (SD 2.27) and the mean time for BFR was 9.52 months (SD 7.64). Fifteen patients (28.3%) required permanent csf diversion with a ventriculoperitoneal shunt. Comminuted skull fractures were found in 30.2% of patients (16/53). 17% (9/53) had a wound infection. Univariate comparisons were made between a number of baseline variables and outcome of BFR. Significant associations were observed with comminuted skull fracture (p=.006), presence of infection (p=.02), hydrocephalus developing after AC (p= 0.01), & the presence of a permanent VPS (p=0.01). 81% (13/16) of patients with comminuted skull fractures, 80% (12/15) requiring permanent VPS, 88.9% (8/9) with post-operative infection, and & 90% (9/10) with hydrocephalus after AC had BFR. None of the other factors showed a significant association with BFR. We then used multivariate analysis to develop a predictive model (logistic regression, forward, conditional). The variables entered were comminuted skull fractures, permanent VPS, and age.
     This is a retrospective study.
     After DC for pediatric TBI, a very large percentage 50.9% of our AC patients experienced BFR.
     Factors associated with BFR in a multivariate model were patients with permanent VPS, comminuted skull fractures, and age.


Project Roles:

C. Bowers (), D. Hertzler (), J. Riva-Cambrin (), M. Walker ()