RESUMEN
In our experience, surgical outcomes in children have been excellent with a low complication rate. Our aim in this study was to better understand what aspects of our current surgical technique have been successful with a view to retain those that are beneficial as we proceed with implantation of future devices. Because the receiver-stimulator and overlying skin flap may be more vulnerable to damage in children than adults, we concentrated on issues related to the positioning and security of this part of the implant on the head. Three specific areas of vulnerability were explored in separate experiments. In Experiment 1, we determined the effect of the position of the device on the ability of a child to roll their head without allowing contact between the device and a supporting surface. The 'freeroll' angle was determined for devices position conventionally (back position) and for those in which the device is placed in a more anterior position (up position). In Experiment 2, we studied the retentive capacity of the child's pericranium and measured the displacement force required to dislodge an implant from the bed if retained by the calvarium only. In Experiment 3, we compared the skull curvature of children in whom the device was placed in the back versus the up position. These results inform us as how to best proceed with implantation in children using future devices that have thinner and wider receiver-stimulators.