Hydroxyapatite Cement Cranioplasty in Translabyrinthine Acoustic Neuroma Surgery

Arriaga, Moisés A.; Chen, Douglas A.

doi:10.1067/mhn.2002.124436

Cited by 58 publications

(67 citation statements)

References 9 publications

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“…The majority of the postoperative photographs (> 80%) reflected a Category I result based on the extended Whitaker scale ( Table 1). The remainder of the patients (approximately 20%) had minor imperfections (ipsilateral supraorbital rim [8 patients], ipsilateral forehead [7], contralateral forehead [1], and ipsilateral temporal constriction [7]) that did not warrant surgical intervention (Category IIA). Among these minor imperfections, ipsilateral temporal constriction was not the most common finding, contrasting with previous published data (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…3 Two-dimensional photography has been widely used and validated to evaluate the characteristics of craniofacial malformations and to assess the effect of therapeutic surgical procedures in the correction of such conditions. 1,3,10,11,22,32 Three-dimensional photography is a novel technology that allows us to capture a patient's superficial craniofacial anatomy in 3 dimensions. 14,19 This revolutionary imaging technology has the potential of quantifying volumetric changes of the facial soft tissues 6,16,19 as well as cranial vault volume.…”

Section: 31mentioning

confidence: 99%

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Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Mesa¹,

Fang²,

Muraszko

et al. 2011

FOC

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Object Successful surgical repair of unicoronal plagiocephaly remains a challenge for craniofacial surgeons. Many of the surgical techniques directed at correcting the stigmata associated with this craniofacial deformity (for example, ipsilateral supraorbital rim elevation [vertical dystopia], ipsilateral temporal constriction, C-shaped deformity of the face, and so on) are not long lasting and often result in deficient correction and the need for secondary revision surgery. The authors posit that the cause of this relapse was intrinsic deficiencies of the current surgical techniques. The aim of this study was to determine if correction of unilateral coronal plagiocephaly with a novel hypercorrection surgical technique could prevent the relapse of the characteristics associated with unicoronal plagiocephaly. Methods The authors performed a retrospective analysis of 40 consecutive patients who underwent surgical repair of unicoronal plagiocephaly at their institution between 1999 and 2009. In all cases, the senior author (S.R.B.) used a hypercorrection technique for surgical reconstruction. Hypercorrection consisted of significant overcorrection of the affected ipsilateral frontal and anterior temporal areas in the sagittal and coronal planes. Demographic, perioperative, and follow-up data were collected for comparison. The postsurgical appearance of the forehead was documented clinically and photographically and then evaluated and scored by 2 independent graders using the expanded Whitaker scoring system. A relapse was defined as a recurrence of preoperative features that required secondary surgical correction. Results The mean age of the patients at the time of the operation was 13 months (range 8–28 months). The mean follow-up duration was 57 months (range 3 months to 9.8 years). The postsurgical hypercorrection appearance persisted on average 6–8 months but gradually dissipated and normalized. No patients exhibited a relapse of unicoronal plagiocephalic characteristics that required surgical correction. In all cases the aesthetic results were excellent. Only 3 patients required reoperation for the management of persistent calvarial bone defects (2 cases) and removal of a symptomatic granuloma (1 case). Conclusions Our study demonstrates that patients who undergo unicoronal plagiocephaly repair with a hypercorrection surgical technique avoid long-term relapse. Our results suggest that the surgical technique used in the correction of unilateral coronal synostosis is strongly associated with the prevention of postsurgical relapse and that the use of this novel method decreases the need for surgical revision.

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Section: Discussionmentioning

confidence: 99%

Section: 31mentioning

confidence: 99%

Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Mesa¹,

Fang²,

Muraszko

et al. 2011

FOC

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“…2,4,52,56 There has been evidence of integration of new bone into the HAC at the periphery of the lesion with no foreign body reaction or inflammatory response, even in animal models. In a series of 54 patients with HAC, Arriaga and Chen 2 reported a reduction in CSF leak from 12.5% to 3.7% when compared with a similar-sized cohort in which only autologous fat was used.…”

Section: Discussionmentioning

confidence: 99%

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

Manjila¹,

Weidenbecher

Semaan

et al. 2013

JNS

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PostoPerative CSF leak after translabyrinthine surgery for removal of an acoustic neuroma (TLAN) is recognized as an infrequent complication, despite the best prophylactic techniques currently available. [29][30][31][32][33]36,40,44 To prevent postoperative CSF leaks after TLAN, several surgical methods have been tried, using different autografts and allografts, alone or in combinations, with varying success rates. 6,8,10,11,13,[22][23][24]27,28,42,46 These range from calvarial bone autografts, bone cements, metals, and resins to resorbable bone plates. 5,6,51 Calvarial grafts can be time consuming and less malleaPrevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma Object. Several prophylactic surgical methods have been tried to prevent CSF leakage after translabyrinthine resection of acoustic neuroma (TLAN). The authors report an improvised technique for multilayer watertight closure using titanium mesh-hydroxyapatite cement (HAC) cranioplasty in addition to dural substitute and abdominal fat graft after TLAN.Methods. The study was limited to 42 patients who underwent TLAN at University Hospitals Case Medical Center using this new technique from 2006 to 2012. Systematic closure of the surgical wound in layers using temporalis fascia, dural substitute, dural sealant, adipose graft, titanium mesh, and then HAC was performed in each case. Temporalis muscle and eustachian tube obliteration were not used. The main variables studied were patient age, tumor size, tumor location, cosmetic outcome, length of hospitalization, and the incidence of CSF leak, pseudomeningocele, and infection.Results. Excellent cosmetic outcome was achieved in all patients. There were no cases of postoperative CSF rhinorrhea, incisional CSF leak, or meningitis. Cosmetic results were comparable to those achieved using HAC alone. This cost-effective technique used only a third of the HAC required for traditional closure in which the entire mastoid defect is filled with cement, predisposing to infection. Postoperative CT and MRI showed excellent bony contouring and dural reconstitution, respectively.Conclusions. The authors report on successful use of titanium mesh-HAC cranioplasty in preventing postoperative CSF leak after TLAN in all cases in their series. The titanium mesh provides a well-defined anatomical dissection plane that would make reoperation easier than working through scarred soft tissue. The mesh bolsters the fat graft and keeps HAC out of direct contact with mastoid air cells, thereby reducing the risk of infection. The cement cranioplasty does not preclude subsequent implantation of a bone-anchored hearing aid.

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“…5,27,30 Postoperative CSF leak rates for all acoustic neuroma surgery have been reported to range between 0% and 30% in the literature, but the mean leak rate remains approximately 10%. 1,[8][9][10]15,17,26,27 The postoperative CSF leak rates after translabyrinthine removal of acoustic neuromas range from 0% to 13% as reported in the most recent literature. 3,6,7,11,18,19,29 Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the translabyrinthine approach is paramount to prevent postoperative CSF leakage.…”

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confidence: 97%

Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note

Liu¹,

Patel

Podolski

et al. 2012

FOC

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Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the translabyrinthine approach is paramount to prevent postoperative CSF leakage. However, primary dural reapproximation and achieving a watertight closure of the dural defect in this anatomical region are quite difficult. Standard closure techniques after the translabyrinthine approach often involve packing an abdominal fat graft that plugs the dural defect and mastoidectomy cavity. This technique, however, may pose the risk of direct compression of the fat graft on the facial nerve and brainstem. Nonetheless, even with the evolution in dural repair techniques, postoperative CSF leaks can still occur and provide a route for infection and meningitis. In this report, the authors describe a novel dural “sling” reconstruction technique using autologous fascia lata to repair presigmoid dural defects created after translabyrinthine resection of acoustic neuromas. The fascia lata is sewn to the edges of the presigmoid dural defect to create a sling to suspend the fat graft within the mastoidectomy defect. A titanium mesh plate embedded in porous polyethylene is secured over the mastoidectomy defect to apply pressure to the fat graft. In the authors' experience, this has been a successful technique for dural reconstruction after translabyrinthine removal of acoustic neuromas to prevent postoperative CSF leakage. There were no cases of CSF leakage in the first 8 patients treated using this technique. The operative details and preliminary results of this technique are presented.

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Hydroxyapatite Cement Cranioplasty in Translabyrinthine Acoustic Neuroma Surgery

Abstract: HAC offers significant CSF leakage control and long-term cosmetic and comfort advantages over AFG alone. We recommend HAC as the standard closure technique for translabyrinthine acoustic neuroma surgery.

Cited by 58 publications

References 9 publications

Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Reconstruction of unicoronal plagiocephaly with a hypercorrection surgical technique

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note

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