Hydroxyapatite bone cement application for the reconstruction of retrosigmoid craniectomy in the treatment of cranial nerves disorders

Abstract

Background:Retromastoid craniectomy (RSC) is a cardinal surgical approach used to access the posterior fossa. Hydroxyapetite bone cement (HBC) is frequently employed for cranioplasty in efforts to prevent cerebrospinal fluid (CSF) leak, whilst maintaining low complication rates and good cosmetic satisfaction. The authors aim to determine the safety and effectiveness of HBC for reconstruction RSC used for treatment of various cranial nerves disorders.Methods:The authors conducted a retrospective one-center two surgeons review of 113 patients who underwent RSC filled with HBC for the treatment of cranial nerve disorders. The study period extended from January 2011 through April 2016. Charts were reviewed for documentation of descriptors pertinent to the endpoints described above. Revisions and reoperations were excluded from analysis.Results:Ninety-three patients met the inclusion criteria; there was one case of postoperative pseudomeningocele, which was considered as CSF leak (1%), 3 (3,2%) superficial infections, and no deep infections. Cosmetic satisfaction was obtained in all but one case (98.9% satisfaction) and long-term incisional pain was problematic in 1 (1.1%) patient. Other complications (serous drainage, headache, ear pain) accounted for three cases (3.2%).Conclusions:The application of HBC in the reconstruction of RSC for the treatment of cranial nerves disorders is an effective method, yielding good cosmetic results whilst eliminating CSF leak. Additionally, it is safe due to the lack of deep-seated wound infections with low incidence of chronic incisional pain.

Prolonged Inflammatory Reaction to Fractured Calcium Phosphate Cement Cranioplasty Secondary to Sequestration Within the Diploe

“…Since the adoption of calcium phosphate cement for calvarial reconstruction, cases using the biomaterial for craniofacial repair and augmentation have been reviewed and well-outlined on the basis of efficacy, complications, and practices to mitigate the risk of complications 4,5 . Of these complications, fracture of the cement paste has been postulated as a potential driver of delayed inflammatory reactions with thinning of skin, breakdown, and wound dehiscence 5,6 . Consistent with these complications, the clinical course outlined in the present case resulted from trauma to the area of previous temporal calcium phosphate cement paste augmentation, with microfragmentation of the cement paste inciting a foreign body reaction.…”

Impact of Reconstruction With Hydroxyapatite Bone Cement on CSF Leak Rate in Retrosigmoid Approach to Vestibular Schwannoma Resection: A Review of 196 Cases

“…An a priori power analysis was performed to evaluate the adequacy of our sample size, demonstrating that our sample size is adequate to compare outcomes with or without cranios to statistical significance defined at p ¼ 0.05 with an effect size of -0.46. Additionally, we evaluated our sample size as it compares to the literature, and our inclusion of 101 subjects closed with Cranios alone is comparable to the standard in the literature assessing various types of bone cement, which range from 100 to 138 patients (15,16,(20)(21)(22)(23)(24).…”