Patel, Hiteshi

Cranioplasty is a critical reconstructive procedure, with research focused on many different areas. Despite this variety, there is a lack of research analyzing the most impactful studies on cranioplasty. The authors conducted a comprehensive search of the Web of Science (WoS) Core Collection for studies on cranioplasty and selected the top 100 articles by citation count. Bibliometric data, study design, materials used, and study sample sizes were extracted. Spearman correlation tests and Kruskal-Wallis tests were conducted to analyze citation patterns. The top 100 cranioplasty studies, published between 1979 and 2020, were cited an average of 136.7 ± 65.1 times. The majority of studies (n = 68) were classified as clinical, while 21 were reviews and 11 were basic science. Most clinical studies were single-center (92.6%), while 7.4% were multicenter studies. Excluding case reports (n = 7), the median sample size in clinical studies was 70 patients (IQR: 25–147). Studies with larger sample sizes received more citations per year on average (rho = 0.44, P < 0.001), and more recent studies tended to use larger sample sizes (rho = 0.37, P = 0.002). Over half (52.3%) of clinical studies included patients who had reconstruction with autologous bone, followed by titanium (32.3%), polymethylmethacrylate (PMMA) (29.2%), hydroxyapatite (12.3%), and polyetheretherketone (9.3%). These findings demonstrate that the most impactful studies on cranioplasty are predominantly single-center investigations, most with <100 patients, yet have significantly shaped the field.

Surgical outcomes and perioperative factors associated with pediatric cranioplasty remain incompletely understood. The authors queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to evaluate outcomes and intraoperative/postoperative blood transfusions in patients undergoing cranioplasty between 2019 and 2023. A total of 249 patients (mean age 9.1 ± 5.4 y) were included. Most cranioplasties (70.7%) utilized alloplastic materials compared with autologous. Blood transfusion was required in 24.1% of cases, predominantly on the day of surgery (86.7%). Multivariable analysis identified age (OR: 0.86 per year, 95% CI: 0.80–0.93, P < 0.001) and cranioplasty size >5 cm (versus ≤5 cm) (OR: 2.10, 95% CI: 1.01–4.50, P = 0.049) as predictors of transfusion. The 30-day unplanned readmission rate was 5.3% at a mean of 14.6 ± 7.9 days from surgery, most commonly for a surgical site infection (33.0%). The 30-day unplanned reoperation rate was 2.9%, at a mean of 10.2 ± 5.6 days. Autologous cranioplasty was not associated with higher odds of readmission (OR: 0.79, 95% CI: 0.25–2.13, P = 0.66) or reoperation (OR: 5.04, 95% CI: 0.96–36.99, P = 0.07) compared with alloplastic cranioplasty. Rates of readmission and reoperation following pediatric cranioplasty are comparable to other complex craniofacial procedures. Younger age and larger cranioplasty size are associated with higher rates of blood transfusion. Our results show that autologous reconstruction is not associated with higher short-term complication rates compared with alloplastic reconstruction, although future studies are still needed to further the understanding of the optimal cranioplasty material.