Pediatric Cranioplasty Especially in Young Children: Options and Decision for Treatment: A Systematic Review

Abstract Cranioplasty in children is associated with a high risk of bone resorption when autologous bone grafts are used, and synthetic implant materials may hamper the growth of the developing calvarium. So, choosing the ideal implant material for cranioplasty according to the age of children is difficult. This article aims to review the literature and to identify the appropriate material and technique for pediatric cranioplasty, especially in young children. A systematic review was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search was performed with the phrase “cranioplasty in pediatric patients” as a search term in PubMed Central, Medline, Google Scholar, and Embase databases to identify all the articles published till June 2025. The systematic review included peer-reviewed original articles, review articles, and keywords in the title and abstract. Out of 157articles searched, 24 articles were included in this review after screening for eligibility. Out of 24 studies, 10 studies were on autologous bone graft for cranioplasty in children, 4 hydroxyapatite, 1 titanium implant, 2 fiber reinforced bioactive glass, 1 polymethylmethacrylate, and 6 on multiple implants. The rate of complications ranged from 0 to a maximum 77%. Based on the analysis of pooled studies, autologous bone flaps, although biocompatible, are prone to resorption, while alloplastic materials may hamper the growth of the developing calvaria, particularly in younger children. Future research should continue to explore the balance between biological and synthetic materials in cranioplasty, aiming to optimize recovery and function for young patients.