Daniel, Demarchi MD 1 , Carlos, Asencio-Cortés MD 2 1. Neurosurgical Department at Sor María Ludovica Children’s Hospital, Buenos Aires, Argentina 2. Neurosurgery Department at Hospital HM Nou Delfos, Barcelona, Spain Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. 3 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. INTRODUCTION One of the last steps of a brain surgery that requires craniotomy is replacing and fixing the bone flap to the skull. In adults, this step has been standardized for many years; among the various methods and fixation systems in the market, the gold standard is fixation with titanium plates and screws 1,2 . However, in children this step has not been so simple to standardize. The main reason for this is that children’s skull is still growing, which makes rigid fixation with plates and screws a less-than-optimal solution. Several studies have reported the potential hazards and complications of this method in children, mainly migration and translocation of the implants 3–6 This is why pediatric neurosurgeons have generally opted for absorbable sutures or fixation devices to close craniotomies in children 7–9 . Absorbable fixations are made of biocompatible and biodegradable materials that are meant to provide strong fixation up until osteosynthesis has taken place, and then predictably degrade 7,10 . However, despite the general acceptance of these options, they still present some flaws. One of the main concerns for resorbable fixation systems is the incidence of foreign body reactions (FBR) to the implant material 10–12 . Despite FBR being usually uneventfully treated, without timely treatment there is risk of bone resorption and long-term complications 12 Fifteen years ago, a new family of craniotomy fixation systems was introduced 13 : based on the clamp principle, Cranial LOOP consists of two poly-ether- ether-ketone (PEEK) platforms, linked by two cable ties, and of two non-implantable parts, the handle and the applier (Fig. 1) . The lower platform is placed under the skull and, after the bone flap is replaced in its original position, the upper platform is tightened by pressing on the applier while pulling on the handle, without any specific instruments, moving the upper platform towards the lower one. At the end, the two platforms clamp the bone flap and the skull between them, favoring a stable union that allows the healing of the bone flap. This system has been marketed around the world and used both in adults and children with good results 13–16 . However, the low number of published pediatric cases using Cranial LOOP makes it hard to assess whether this system effectively tackles the complications observed in resorbable fixations. Fig. 1 Cranial LOOP device. a Intraoperative image showing four Cranial LOOPs with their handle and appliers on the union between the bone flap and the skull, b intraoperative image from the same case showing four Cranial LOOPs after removing the non-implantable parts and cutting off the ties, c CT scan image showing the fixated bone flap from the same patient. 4 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. This manuscript presents a retrospective study of pediatric neurosurgical procedures performed through craniotomy in which the bone flap was fixed back to the skull using Cranial LOOP. The main objective of this study is to assess the performance and safety of Cranial LOOP in pediatric patients. Furthermore, this retrospective study includes a subpopulation of patients under 3 years of age who had their bone flap fixed with Cranial LOOP off-label according to its instructions for use (IFU), so a secondary objective of this study is to assess the performance and safety of Cranial LOOP in children under this age. METHODS This study was performed with retrospective data from Sor María Ludovica Children’s Hospital (Buenos Aires, Argentina). The local ethics board has approved the use of anonymized data from 60 children who underwent craniotomy bone flap fixation using Cranial LOOP (Approval code CAPI_0082). The patients included in this study had their surgeries performed between October 2014 and July 2024. The inclusion criteria for this study were: being a pediatric patient (in Argentina this includes all patients under 15 years of age), having had a craniotomy and bone flap fixation using any of the Cranial LOOP family products, having had at least one radiological assessment after surgery and a minimal follow-up of 3 months. The only exclusion criterion of this study was for patients who had had their bone flap fixation performed with a combination of other fixation methods. It is important to note that this retrospective study did not exclude younger than 3-year-old patients who had their bone flap fixed with Cranial LOOP in an off-label use. Besides basic demographic data (age, sex, height and weight) the clinical reason for surgery and history of previous craniotomies were also collected. As for the surgical intervention, the data collected included the type of surgery, the location, shape and size of the bone flap, the number and size of the Cranial LOOP devices used, and the occurrence of intraoperative complications. Up to three follow-up visits were registered for each patient, and for each of these clinical visits bone flap stability, cranial growth and cosmetic outcomes were recorded. Bone flap stability and cranial growth were assessed via palpations and through X rays. Follow-up visits have been classified as short-term (up to 90 days after surgery), mid-term (between 90 days and one year after surgery) and long- term (more than one year after surgery). Finally, up to three CT scans were registered for each patient and the alignment of the bone flap at each device location and the fusion of the bone flap to the skull were assessed. Bone fusion was identified as bone density changes on non-ossified areas around the bone flap. Any postoperative complications have been registered until the end of follow-up for each patient. Special attention has been paid to the most common post- operative fixation-related complications in pediatric patients undergoing bone flap fixation, such as FBR, bone resorption and surgical infections, as well as re- interventions. Descriptive statistics have been tabulated for pre- surgical, surgical and follow-up variables. Continuous variables have been described with the mean ± standard deviation, the median, the minimum and the maximum. Categorical variables have been described with absolute and relative rates. The analysis has been performed for two populations, so that 60 patients were included in the global population (all patients) and 17 patients were included in the off-label subpopulation (patients younger than 3 years old). RESULTS Global population: Baseline demographics and surgery data The study population included 60 patients with mean age of 6.5±4.1 years, ranging from 8 months to 15 years of age at the time of surgery. 66.7% of cases had a brain tumor. Two of the cases in this study had had a craniotomy prior to the registered case. More detailed demographic, anthropometric and clinical data can be found in Table 1. 5 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. Most surgeries registered in this study were tumor resections (66.7%) and the most common craniotomies were bilateral (45.0%) and on the occipital area of the skull (45.0%). The bone flap was rectangular or square- shaped in almost all cases (95.0%) with a mean size of 20.8±7.5 cm 2 . The common practice in this hospital is using either Cranial LOOP or Cranial LOOP L for the fixation of the bone flap of each patient (without size combination). As a median, the bone flap fixation was either performed with three Cranial LOOP or with two Cranial LOOP L. More details on the perioperative data can be found in Table 2 . None of the registered cases had intraoperative complications. The mean follow-up registered from these patients was 564.6 days, ranging from 102 days to 7 years; 20 patients could not be followed up in the study center for at least 1 year. Seven patients died during their follow-up due to their base condition. Short-term follow-up (< 90 days) Short-term follow-up data was available for 57 patients who had at least one visit in this period of time. In all cases the fixation was assessed as stable, the cranial growth was considered correct and the cosmetic outcome was satisfactory. In addition, in 45 of these cases a CT scan was performed. The images showed that the bone flap was properly aligned at all the fixation points in all cases. Mid-term follow-up (90 days – 1 year) Mid-term follow-up data was available for 27 patients who had at least one visit in this period of time. In all cases the fixation was assessed as stable, the cranial growth was considered correct and the cosmetic outcome was satisfactory. In addition, 35 patients had at least one CT scan performed during this period of time that showed an aligned bone flap at all the fixation points in all cases. Long-term follow-up (> 1 year) Long-term follow-up data was available for 33 patients, with a maximum follow-up period of seven years. In all cases the fixation was assessed as stable, the cranial growth was correct and the cosmetic outcome was satisfactory. Twenty-one of these cases included at least one CT scan evaluation that showed an aligned bone flap at all the fixation points in all cases. Bone fusion Bone fusion was evaluated in patients with at least one CT scan. As early as 189 days after surgery there were cases with complete bone fusion. Bone fusion progressed adequately, with the proportion of patients showing at least partial bone fusion in their CT scans increasing up to 90.5% of cases during the registered follow-up (see Fig. 2) . There were two cases that did not show complete bone fusion more than 1 year after surgery: one of them was because they had had a reintervention before the CT scan; the patient showed bone fusion 203 days after the reintervention surgery. Safety During the follow-up of these patients there were no complications registered related to the bone flap fixation; specifically, there were no cases of FBR, bone resorption or wound infections. There were only three postoperative complications among the studied population, two of them were unresolved epilepsy and the other one was an auto-inflicted lesion that resulted in an exposition of the wound. Fig. 2 Bone fusion progression evaluated through CT scan during the registered follow-up. Short-term N = 45 (global) and 13 (younger than 3 years old); mid- term N = 35 (younger than 3 years old), 10 (off-label); long-term N = 21 (global) and 5 (younger than 3 years old). 6 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. Reinterventions Seven of the patients had to be reintervened during the follow-up. In all of them, except for one case of refractory epilepsy, reintervention was due to tumor relapse or removal of residual tumor. These reinterventions were performed a mean of 599.6±394.8 days after surgery. In all the reinterventions removal of the fixation devices was considered easy. In six of the reinterventions at least partial bone fusion was observed. The case that did not show bone fusion during the reintervention was performed 142 days after surgery. Cranial LOOP was used again to fix the bone flap after all these reinterventions. Off-label subpopulation (< 3 years old) The off-label subpopulation included 17 patients with mean age of 20.9±8.6 months at the time of surgery. More detailed demographic, anthropometric and clinical data can be found in Table 1. In this subpopulation, the bone flap mean size was 17.6±4.9 cm 2 , and the fixation was achieved either with a median of 3-4 Cranial LOOP or with 3 Cranial LOOP L. Same as in the global population, in all the follow-up assessments (short-, mid- and long-term) the fixation stability, bone growth and cosmetic outcome was good. As early as 198 days after surgery an off-label patient had complete bone fusion, and all five cases who had a CT scan more than one year after surgery had at least partial bone fusion (see Fig. 2) . Two of the cases that required reintervention were part of the off- label subpopulation and in both cases, bone fusion was observed. Same as in the global population, there were no complications related to the bone flap fixation in these cases. DISCUSSION This retrospective study demonstrates that Cranial LOOP is a safe and efficient method to fix the bone flap after a craniotomy in pediatric patients. The main results from this study are the lack of fixation-related complications or reinterventions, the high rate of bone fusion, and the adequate bone growth in all the cases registered. To our knowledge, there are very few published studies evaluating cranial bone flap fixation methods in children. A revision of the literature shows that resorbable sutures and resorbable plates and screws are the most used systems in neurosurgical pediatric procedures 7, 8, 17–19 . The use of titanium plates and screws in children is nearly anecdotical 6 and no evidence of the use of other fixation systems (such as titanium clamps) has been found. Both resorbable systems and titanium plates and screws have small but relevant incidences of wound infections, bone resorption, growth issues, and cosmetic defects in pediatric patients (Table 3) Despite the intrinsic differencesbetween the intervention described in our investigation and the use of absorbable and titanium fixations to reconstruct the skull of patients with craniosynostosis 7, 17–20 , Cranial LOOP achieved comparable or even better safety results, with no related complications, while allowing similar bone healing and without some of the cosmetic issues that had been reported by Imola et al. 7 . When compared to the published experiences for autologous cranioplasties 21, 22 , which share similar affected areas and the shape of bone flaps being fixed, Cranial LOOP did not cause bone resorption and there were no cases of wound infection. It is also worth noting that we did not find any cases of inflammation and/or granuloma caused by the implants, which had been previously reported for resorbable fixation systems 11, 12 When comparing the cost of the different fixation methods used in the pediatric population 8 , Cranial LOOP cost may vary in different regions but is in the range of the cost of resorbable plates and screws and titanium clamps. To our knowledge, this is the first article reporting off- label use of Cranial LOOP in children younger than 3 years old in the literature. The results obtained in this subpopulation, despite the smaller sample size, seem to indicate similar outcomes to the general pediatric population, providing a stable fixation with no related complications and good cosmetic results. It is worth noting that, in this subpopulation, all the children evaluated through CT scan showed bone fusion from 7 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. 1 year after surgery, which confirms that Cranial LOOP allows bone growth and fusion even in very young children. This off-label use of Cranial LOOP is common among all surgeons in our hospital and other hospitals in our country. Another relevant aspect of this study is the use of Cranial LOOP to fix occipital craniotomies in posterior fossa surgeries. In the pediatric population, most oncologic cases are found in this region, which pose a challenge for bone flap fixation after surgery 23-25 . The surgeons’ experience with this retrospective study is that Cranial LOOP was an effective and easy to use method to fix the bone flap in these cases because the devices were easier to adapt to this complicated area than resorbable plates and more stable than sutures; the surgeon usually fixed the bone flap with two devices on the most homogeneous surfaces and made use of the musculature in the area to secure the bone flap in place. Other strategies to deal with posterior fossa tumors have been described, such as osteoplastic craniotomy using the ligamentous osteoplastic midline posterior fossa craniotomy (LOM-PFC) technique 26,27 Comparing these results with a previously published retrospective study performed on general population with the same fixation method 14 , despite the different study population (general vs pediatric), the observed outcomes are very similar. In the present study all patients had stably aligned bone flaps at all time points, while the previous study showed very few cases of misaligned bone flap (and the identified misalignments were not clinically significant). This confirms that Cranial LOOP achieves a stable fixation both in pediatric and general populations. Similarly, the safety results from this study are very similar to the previously published one, with no serious complications related to Cranial LOOP in either of them. The main differences between these two studies are, besides the population age, the fact that in this study most craniotomies were performed in the occipital area while the previous study had mostly frontal craniotomies. Both studies confirm that the main advantages of Cranial LOOP are its adaptability, ease of use (no need of specific instruments), lack of radiological artifacts and compatibility with radiotherapy (no heating of the implants) 14 There are three main limitations for this study. The first and most relevant one is the fact that it is a retrospective study that uses clinical data collected as part of the standard of care for these patients; this has caused a lack of homogeneous follow-up schedule for all patients. Furthermore, this has limited the availability of specific variables that would otherwise have been interesting to collect in this study, such as surgical fixation time. Another limitation of this study is the fact that we could not obtain retrospective data from all the consecutive patients in the registered period. This is due to the highly specialized cases the department involved in this study deals with (pediatric oncology) and thus patients are referred from a large area for surgery but are subsequently lost to follow- up, which is often performed locally. Finally, there is very scarce literature with comparable setting and study population, which makes the results obtained hard to discuss; however, the surgeons involved in the study have been using it for 10 years and, prior to the implementation of this system in our hospitals, we had used sutures, metallic plates and resorbable fixations; in our experience, sutures did not provide as much stability, metallic plates are not indicated for children younger than 10 years, and resorbable fixations take significantly more time to use during surgery, mainly because of the instrument related logistics required to implant these devices. After introduction of Cranial LOOP for bone flap fixation in children, its tool-free implantation has significantly reduced the logistics surrounding the bone flap fixation, thus reducing the fixation time. Despite these limitations, we consider that this study provides systematically collected data on relevant outcomes of the craniotomy fixation method described, particularly in a population where this aspect has been seldom analyzed. CONCLUSIONS Cranial LOOP is a safe and effective method to fix the bone flap after craniotomy in children, even in patients younger than 3 years old. This adds a new tool to treat patients with growing skull bones. 8 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. Table 1. Demographic, anthropometric and clinical data of the study population. Global (N=60) Younger than 3 years old (N=17) Demographic data Mean ± SD Median (Min-Max) Mean ± SD Median (Min-Max) Age 6.5±4.1 (years) 6.7 (0.7 – 15.0) 20.9±8.6 (months) 18.8 (8.5 – 35.6) N (%) N (%) Sex - Female 27 (45.0%) 8 (47.1%) Male 33 (55.0%) 9 (52.9%) Anthropometric data Mean ± SD Median (Min-Max) Mean ± SD Median (Min-Max) Height – cm 111.5±28.3 112.0 (60.0 – 165.0) 79.5±11.2 82.0 (60.0 – 95.0) Weight – kg 28.6±17.6 24.7 (6.0 – 80.0) 11.9±4.1 12.0 (6.0 – 20.0) Reason for surgery N (%) N (%) Brain tumor 40 (66.7%) 11 (64.7%) Craneoencephalic trauma 10 (16.7%) 2 (11.8%) Vascular pathology 4 (6.7%) 0 (0%) Cyst 4 (6.7%) 2 (11.8%) Hydrocephalus 1 (1.7%) 1 (5.9%) Epilepsy 1 (1.7%) 1 (5.9%) TABLES Author contribution All authors contributed to the study conception and design. Data collection and analysis were performed by Dr Daniel Demarchi. The first draft of the manuscript was written by Dr Daniel Demarchi. Dr Carlos Asencio-Cortés commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding The authors did not receive support from any organization for the submitted work. 9 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. Table 2. Surgery details. Global (N=60) Younger than 3 years old (N=17) Surgery details N (%) N (%) Surgery type: Tumor resection 40 (66.7%) 11 (64.7%) Drainage 6 (10.0%) 2 (11.8%) Cranioplasty 6 (10.0%) 2 (11.8%) AVM resection 2 (3.3%) 0 (0%) Decompressive craniectomy 1 (1.7%) 0 (0%) Other* 5 (8.3%) 2 (11.8%) Craniotomy area: Occipital 27 (45.0%) 8 (47.1%) Temporoparietal 10 (16.7%) 2 (11.8%) Parietal 8 (13.3%) 2 (11.8%) Frontal 6 (10.0%) 2 (11.8%) Frontoparietal 5 (8.3%) 2 (11.8%) Frontoparietotemporal 2 (3.3%) 1 (5.9%) Temporal 2 (3.3%) 0 (0%) Craniotomy side: Bilateral 27 (45.0%) 8 (47.1%) Right 20 (33.3%) 6 (35.3%) Left 13 (21.7%) 3 (17.6%) Craniotomy shape: Square/rectangle 57 (95.0%) 15 (88.2%) Circle 1 (1.7%) 1 (5.9%) Oval 1 (1.7%) 1 (5.9%) Irregular 1 (1.7%) 0 (0%) Cranial LOOP model used: Cranial LOOP 31 (51.7%) 8 (47.1%) Cranial LOOP L 29 (48.3%) 9 (52.9%) Mean ± SD Median (Min-Max) Mean ± SD Median (Min-Max) Bone flap area – cm 2 20.8±7.5 20.0 (12.0 – 56.0) 17.6±4.9 16.0 (12.0 – 25.0) Devices (both sizes) used 2.9±0.8 3.0 (2.0 – 4.0) 3.1±0.8 3.0 (2.0 – 4.0) Cranial LOOP used 3.3±0.6 3.0 (2.0 – 4.0) 3.5±0.5 3.5 (3.0 – 4.0) Cranial LOOP L used 2.5±0.7 2.0 (2.0 – 4.0) 2.8±0.8 3.0 (2.0 – 4.0) * One serious cranioencephalic trauma, one cyst microsurgical fenestration, one left functional hemisferectomy, one temporal horn exclusion and one refractory epilepsy. 10 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. REFERENCE LIST 1. Smith SC, Pelofsky S. Adaptation of rigid fixation to cranial flap replacement. Neurosurgery 1991;29(3):417. doi:10.1097/00006123-199109000-00013 2. Lerch KD. Reliability of Cranial Flap Fixation Techniques: Comparative Experimental Evaluation of Suturing, Titanium Miniplates, and a New Rivet-like Titanium Clamp (CranioFix): Technical Note. Neurosurgery . 1999;44(4):902- 905. doi:10.1097/00006123-199904000-00137 3. Duke BJ, Mouchantat RA, Ketch LL, Winston KR. Transcranial Migration of Microf ixation Plates and Screws. Pediatr Neurosurg . 1996;25(1):31-35. doi:10.1159/000121093 4. Fearon JA, Munro IR, Bruce DA. Observations on the use of rigid fixation for craniofacial deformities in infants and young children. 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N Surgical indication Wound infection Bone issues Growth issues Cosmetic issues Resorbable fixation systems Kalmar et al (2021) 325 Craniofacial reconstruction 2.5% 7.3% 0.0% 0.0% Ahmad et al (2008) 146 Craniosynostosis 3.4% - - 4.1% Sanger et al (2007) 52 Craniosynostosis 1.9% - - 9.6% Imola et al (2001) 57 Mixed a 3.5% - - 24.6% Titanium plates and screws Berryhill et al (1999) 96 Mixed b 5.2% - 4.2% 13.5% Polymer clamp-like system Current investigation 60 Mixed c 0.0% 0.0% 0.0% 0.0% a 70.2% craniosynostosis, 19.3% craniofacial trauma and 10.5% base skull tumor b 45.8% craniosynostosis, 21.9% tumor, 8.3% skull defect, 24% other diagnosis c See Table 1 11 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. 13. Van Loock K, Menovsky T, Kamerling N, De Ridder D. 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Martin KD, Franz B, Kirsch M et al (2014) Autologous bone flapcranioplasty following decompressive craniectomy is combined with a high complication rate in pediatric traumatic brain injury patients. Acta Neurochir (Wien) 156:813–824. https:// doi. org/ 10.1007/ s00701- 014- 2021-0 23. Keng A, Stewart DE, Sheehan KA (2022) Neuropsychiatric symptoms after brain tumor resection in children and adolescents: a scoping review. J Acad Consult Liaison Psychiatry 63:110–118. https:// doi. org/ 10. 1016/j. jaclp. 2021. 06. 007 24. Legnani FG, Saladino A, Casali C et al (2013) Craniotomy vs. craniectomy for posterior fossa tumors: a prospective study to evaluate complications after surgery. Acta Neurochir (Wien) 155:2281–2286. https:// doi. org/ 10. 1007/ s00701- 013- 1882-y 25. Sastry RA, Walek K, Leary OP et al (2022) Incidence, characteristics, and outcomes of pseudomeningocele and cerebrospinal fluid fistula after posterior fossa surgery. World Neurosurg 164:e1094–e1102. https:// doi. org/ 10. 1016/j. wneu. 2022. 05. 102 26. Jaiswal M, Jaiswal S, Chandra A, Krishna BO (2022) Experience with osteoplastic posterior fossa craniotomy in 13 children. J Pediatr Neurosci 17:209–216. https:// doi. org/ 10. 4103/ jpn. jpn_230_ 20 27. Prell J, Scheller C, Alfieri A et al (2011) Midline-craniotomy of the posterior fossa with attached bone flap: experiences in paediatric and adult patients. Acta Neurochir (Wien) 153:541–545. https:// doi. org/ 10. 1007/ s00701- 010- 0924-y NEOS SURGERY S.L www.neosurgery.com C/Ceramistes, 2 08290 - Cerdanyola del Vallès (BARCELONA) - SPAIN All trademarks and company names are the property of their respective owners. FC05CL01 See original publication: Demarchi, D., Asencio-Cortés, C. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion. Childs Nerv Syst 42 , 54 (2026). https://doi.org/10.1007/s00381-026-07148-5. Bone flap fixation with a polymeric clamp-like device in pediatric patients: a safe and effective method that allows bone growth and fusion.