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

Abstract

4. Laryngoscope, 127:2120-2125, 2017.

Hydroxyapatite cement cranioplasty for translabyrinthine surgery: A single institution experience

“…Our complication rates fall within these wide ranges. In the last decade, several large reports have been published with very low rates of CSF leak and wound infection, both with abdominal fat grafting and combined abdominal fat‐HAC cranioplasty . These findings are encouraging because low infection rates with the combined approach further suggest that HAC does not intrinsically lead to wound infection.…”

“…Finally, cost is an important issue in the discussion of biomaterials. Prior studies have demonstrated comparable costs between HAC and other reconstructions in retrosigmoid cranioplasty, although greater HAC volume is needed for repair of translabyrinthine defects . Our institution forbids publication of contract pricing, but the national average price of a comparable formulation has been reported as $820 for 3 cc, which would yield a total price per patient of $4,000 to $7,000.…”

“…For example, Kerr et al reported a high (7%) delayed extrusion rate for HAC, in some cases up to 12 years after surgery, and recommended against its use; however, delayed extrusion was not noted in other contemporary studies. Arriaga and Chen reported a 19‐year experience with combined AFG‐HAC (AFG is defined as abdominal fat graft) closures with excellent CSF leak rates and no delayed extrusion events, although with 1% of patients experiencing wound infections after 1 year postoperatively . Kveton and Coelho reported a 10‐year experience with HAC cranioplasty without any delayed extrusion events …”

“…Adoption of HAC to lateral skull base surgery has been slower, although reports exist of successful use after suboccipital craniotomy . Furthermore, combined autologous fat‐HAC repair of translabyrinthine craniotomy defects has been reported with long‐term success …”

Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa

“…Hydroxyapatite has been used since the early 1990s for cranioplasty and skull base reconstruction including following translabyrinthine surgery. 7 Its superiority over bone wax in sealing bony defects and cell tracts in the petrous apex has resulted in a marked reduction in CSF leaks associated with the retrosigmoid approach. 8 …”