Background: Pediatric calvarial reconstruction is challenging because of the unique anatomical and growth considerations in this population. Comparative studies evaluating current cranioplasty materials are lacking. This review addresses the knowledge gap in pediatric cranioplasty outcomes with emphasis on current materials used. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome data comparing fresh bone, banked bone, titanium, poly(methyl methacrylate), and polyetheretherketone were abstracted. Results: Twenty studies met the authors' selection criteria. The mean patient age ranged from 4 to 17.4 years. Autologous cranioplasty was performed in 439 patients, and 201 patients underwent alloplastic reconstruction. Fresh bone grafts and titanium mesh were associated with the lowest infection rates (0.4 percent and 3.3 percent, respectively; p < 0.001), graft failures (2.9 percent and 3.3 percent, respectively; p < 0.001), and surgical-site occurrence rates (8.8 percent and 6.7 percent, respectively; p < 0.001). Banked bone flaps had the highest overall complication rates (51 percent; p < 0.001), bone resorption (39.7 percent; p < 0.001), and failure rates (40.2 percent; p < 0.001), whereas polyetherether ketone had the highest rates of infection (16.1 percent; p < 0.001). Conclusions: Based on the available evidence to date, fresh bone grafts and titanium mesh demonstrated the lowest surgical-site infection, surgical-site occurrence, and graft failure rates. Banked bone flaps had the highest overall surgical-site complications and graft failures. Pediatric cranioplasty outcomes studies are needed to evaluate current and novel cranioplasty materials.
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