Reduced CSF leak in complete calvarial reconstructions of microvascular decompression craniectomies using calcium phosphate cement.
OBJECT
Calcium phosphate cement provides a biomaterial that can be used for calvarial reconstruction in a retrosigmoid craniectomy for microvascular decompression (MVD). This study evaluates the outcomes of postoperative CSF leak and wound infection for patients undergoing a complete cranioplasty using calcium phosphate cement versus incomplete cranioplasty using polyethylene titanium mesh following a retrosigmoid craniectomy for MVD.


METHODS
The authors evaluated 211 cases involving patients who underwent first-time retrosigmoid craniectomies performed by a single attending surgeon fortrigeminal neuralgia from October 2008 to June 2014. From this patient population, 111 patients underwent calvarial reconstruction after retrosigmoid craniectomy using polyethylene titanium mesh, and 100 patients had reconstructions using calcium phosphate cement. A Pearson's chi-square test was used to compare postoperative complications of CSF leak and wound infection in these 2 types of cranioplasties.


RESULTS
The polyethylene titanium mesh group included 5 patients (4.5%) with postoperative CSF leak or pseudomeningocele and 3 patients (2.7%) with wound infections. In the calcium phosphate cement group, no patients had a CSF leak, and 2 patients (2%) had wound infections. This represented a statistically significant reduction of postoperative CSF leak in patients who underwent calcium phosphate reconstructions of their calvarial defect compared with those who underwent polyethylene titanium mesh reconstructions (p = 0.03). No significant difference was seen between the 2 groups in the number of patients with postoperative wound infections.


CONCLUSIONS
Calcium phosphate cement provides a viable alternative biomaterial for calvarial reconstruction of retrosigmoid craniectomy defects in patients who have an MVD. The application of this material provides a biocompatible barrier that reduces the incidence of postoperative CSF leaks.
['Eseonu|Chikezie I|CI|', 'Goodwin|C Rory|CR|', 'Zhou|Xin|X|', 'Theodros|Debebe|D|', 'Bender|Matthew T|MT|', 'Mathios|Dimitrios|D|', 'Bettegowda|Chetan|C|', 'Lim|Michael|M|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001672:Biocompatible Materials D001843:Bone Cements D002130:Calcium Phosphates D065634:Cerebrospinal Fluid Leak D056424:Decompressive Craniectomy D005260:Female D006801:Humans D015994:Incidence D008297:Male D061145:Microvascular Decompression Surgery D008875:Middle Aged D012189:Retrospective Studies D013526:Surgical Mesh D013530:Surgical Wound Infection D014025:Titanium D014277:Trigeminal Neuralgia D055815:Young Adult
microvascular decompression calcium phosphate retrosigmoid craniectomy infection cranioplasty titanium mesh MMA = methyl methacrylate MVD = microvascular decompression cerebrospinal fluid leak diagnostic and operative techniques