Management and outcomes of craniectomy and cranioplasty in pediatric intracranial infections: a multicenter cohort study

BACKGROUND: In recent years, there has been a noticeable increase in severe intracranial infections among pediatric patients, often requiring craniotomy or decompressive craniectomy. However, determining the optimal timing and material for cranioplasty in pediatric patients presents an ongoing challenge. METHODS: We conducted a multicenter retrospective cohort study of pediatric patients treated between 2013 and 2024. A total of 76 children with intracranial infections were included; 37% of those underwent decompressive craniectomy. Of these, 21% subsequently received cranioplasty using various graft materials. Clinical, microbiological, radiological, and neurosurgical data were analyzed to assess risk factors, outcomes, and complications. RESULTS: Craniectomy was significantly associated with the presence of sinusitis (p = 0.025) and paresis (p = 0.006). Streptococcus intermedius was the predominant pathogen identified in the craniectomy group (p < 0.001). Cranioplasty was performed in 16 patients at a median of 6.9 months post-craniectomy, with a low complication rate (6.25%, one wound impairment). Functional outcome improved significantly in patients with hemicraniectomy after cranioplasty with favorable mRS scores at 3-month follow-up (p = 0.037). CONCLUSION: Craniectomy is frequently required in pediatric patients with severe intracranial infections and is followed by delayed cranioplasty with low complication rates in our cohort. Careful timing and individualized material selection are essential for safe and successful cranial reconstruction in this vulnerable population.