Cranioplasty of Hemispherical Defects Using Calcium Phosphate Cements Along with Titanium Mesh: Our Experience

Abstract

Introduction Cranial defects may arise due to trauma, infection, surgical ablation or errors in development. Restoration of such defects is important for esthetics, function and morale of the patient. Several materials are available. Each has its advantages and disadvantages. Search is on for an ideal material. Autogenous grafts remain the gold standard in reconstruction of such defects. However, the morbidity associated with their harvest, additional time required, the need for a second surgical site and the limited supply has led to the search for newer substitutes. Although many materials are available today including biologic and non biologic substitutes, there is still no consensus about the best material. In this article we describe our use of calcium phosphate cements for reconstruction of hemispherical cranial defects. Materials and Methods Cases requiring reconstruction of hemispherical cranial defects (more than 15 cm in any dimension) were selected for study. After exposing the defect under GA, titanium mesh was adapted to the defect for support. Then the calcium phosphate cement was prepared and injected on the mesh to establish good contour. The alloplastic insert in each patient was evaluated for: (a) Immediate post-operative complications (b) Restoration of contour and soft tissue support (c) New bone formation ascertained on HRCT at the end of 2 years. Patients were examined on postoperative first week, at 3 and at 6 months.High resolution computed tomography scans were taken at 2 years postop. There were two female and three male patients. Results There were no complications in the post operative period. The general condition of the patients improved post operatively. Even though the cements maintained their contour at 2 years, there were no signs of bone formation within the cement. Conclusion Calcium phosphate cement is a good bone substitute for use in cranioplasty. In defects requiring mechanical strength, it should be supported by a titanium mesh. It retains the contour but is not replaced by bone even after 2 years.

Utilization of carbonated calcium phosphate cement for contouring cranioplasty in patients with syndromic craniosynostosis

“…The patients in the present study experienced postoperative improvement in forehead contour as quanti ed using the Whitaker classi cation system [34]. Improvement in cranial contour with this alloplastic material is generally well accepted [18, 19,26,30]. The immediate postoperative improvement in this patient cohort was sustained at an average of over 18 months postoperatively, indicating that at least in medium-term follow-up, the aesthetic improvement is durable.…”

“…Utilization of titanium mesh to absorb dural pulsations has been suggested to lower the risk of cement fracture [6,7]. Finally, thin application of cement, on the order of 5mm or less, is standard at our institution, as the existing histologic evidence does not suggest that this alloplastic material is replaced by native bone to any great extent, even with long-term follow up [19,31]. Still, there is limited revascularization and replacement of CCP cement particularly at the periphery of the implant [14], suggesting that optimizing the surface areas to volume ratio with a thin onlay would be more resistant to chronic infection than thick onlays.…”

Utilization of Carbonated Calcium Phosphate Cement for Contouring Cranioplasty in Patients with Syndromic Craniosynostosis

“…The patients in the present study experienced postoperative improvement in forehead contour as quanti ed using the Whitaker classi cation system [34]. Improvement in cranial contour with this alloplastic material is generally well accepted [18, 19,26,30]. The immediate postoperative improvement in this patient cohort was sustained at an average of over 18 months postoperatively, indicating that at least in medium-term follow-up, the aesthetic improvement is durable.…”

Craniofacial Reconstruction by a Cost-Efficient Template-Based Process Using 3D Printing

“… 11 To achieve an adequate contour of large-size defects in cranioplasty, an additional application of cement over the titanium mesh may be needed. 12 The use of nonmetal allografts like PMMA has been a gold standard among neurosurgeons for many years. Acrylate polymers were already being used in the 1940s during World War II.…”