Delayed Extrusion of Hydroxyapatite Cement After Transpetrosal Reconstruction

Abstract

Delayed extrusion of hydroxyapatite cement resulted in significant morbidity to our patients and often presented in an indolent manner. We recommend serial examination and imaging studies in patients who have had transpetrosal closures with hydroxyapatite cement. Because of the complication rates associated with hydroxyapatite cement, we have discontinued its use.

Hydroxyapatite cement cranioplasty following translabyrinthine approach: Long‐term study of 369 cases

“…Our cohort provides long‐term information about implant integrity and supports the conclusion that adverse events following HAC cranioplasty are low. Our data is statistically similar to that of previous studies of HAC cranioplasty, in spite of the others' concerns that the material was not safe for use in skull‐base surgery. We conclude that the outcomes data for HAC cranioplasty is reproducible, and that it is an error to think that HAC cranioplasty carries an unacceptably high risk of infection and/or extrusion.…”

“…We compared our data for both types of adverse events (CSF leak and infection) with three other series . Bayesian estimates indicated similar complication rates (median, 95% CI): Kveton, et al 4.2% (1.2%, 8.4%); Poetker, et al 3.4% (0.5%, 8.2%), Kerr, et al 7.7% (4.0%,12%), and our cohort 4.0% (2.2%, 6.1%).…”

“…Due to the small number of studies and the inability to separate TL approaches, all skull‐base approaches were included in the comparison. We included Kveton et al (109 patients, 1 CSF leak, 3 wound infections, no TL approaches), Poetker et al (76 patients, 0 CSF leaks, 2 infections, fewer than 43 TL approaches), and Kerr et al (177 patients, 0 CSF leaks, 13 infections, various approaches) . We compared these studies with our cohort using Bayesian analysis with prior probabilities set to a uniform distribution of possible complication rates between 0% and 100% (beta distribution α= 1, β= 1).…”

“…As a result of the findings, these authors abandon the use of HAC. Several years later, after three additional patients developed infected HAC, the same series resurfaced in the literature, including three patients who were left out of the 2006 article, for an incidence of 7.3% HAC infection …”

Immediate Titanium Mesh Cranioplasty for Treatment of Postcraniotomy Infections

“…Hydroxyapatite, a calcium based bone cement that offers benefits of increased osteoconduction and osteointegration, is also an option. It to, however, can become infected and has also been described to cause an intense foreign body inflammatory reaction and extrusion [8–10]. Another alternative, dynamic titanium mesh, has the favorable qualities of high tensile strength and biologic inertness.…”