title: Calcium Phosphate Cement Cranioplasty Decreases the Rate of Cerebrospinal Fluid Leak and Wound Infection Compared with Titanium Mesh Cranioplasty: Retrospective Study of 672 Patients.
abstract: OBJECTIVE
  A variety of biomaterials have been developed for cranial reconstruction after craniectomy, including polyethylene titanium mesh and calcium phosphate cement. This study sought to compare complication rates of calcium phosphate cement and titanium mesh cranioplasty in patients undergoing retromastoid craniectomy.
  
  
  METHODS
  The authors retrospectively reviewed clinical data from 672 consecutive patients who underwent retromastoid craniectomy at a single institution for microvascular decompression or tumor resection from July 2009 to July 2014. Of these, 336 patients received calcium phosphate cement cranioplasty and 336 underwent (polyethylene) mesh cranioplasty. Charts were abstracted for occurrence of cerebrospinal fluid (CSF) leak, wound infection and/or other wound complication, and the groups were compared.
  
  
  RESULTS
  In the mesh cranioplasty group, there were 38 complications related to the surgical site, including 18 infections (5.4%), 20 patients (6%) with CSF leak or pseudomeningocele, and no (0%) other wound complications. In the cement cranioplasty cohort, 2 patients (0.6%) experienced wound infection, no patients (0%) had CSF leak, and 2 patients (0.6%) had other wound complications (including one sterile wound dehiscence and one reoperation for removal of excess cement). There was a statistically significant decrease in the rate of wound infection and CSF leak in the patients who underwent cement cranioplasty (P <0.001 for both).
  
  
  CONCLUSIONS
  Calcium phosphate cement cranioplasty offers an alternative to titanium cranioplasty and may reduce the risk of surgical site complication. Randomized, prospective comparisons of cement cranioplasty to traditional techniques are warranted.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Foster
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Shin
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Prabhu
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fredrickson
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: sekularf@upmc.edu.
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Sekula
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000601:surgery; D002130:Calcium Phosphates / Q000627:therapeutic use*; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology*; D056424:Decompressive Craniectomy; D005260:Female; D020435:Glossopharyngeal Nerve Diseases / Q000601:surgery; D019569:Hemifacial Spasm / Q000601:surgery; D016697:Herpes Zoster Oticus / Q000601:surgery; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery; D008875:Middle Aged; D020959:Polyethylene; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014025:Titanium; D014277:Trigeminal Neuralgia / Q000601:surgery; D055815:Young Adult
chemical_list: D001843:Bone Cements; D002130:Calcium Phosphates; D020959:Polyethylene; C020243:calcium phosphate; D014025:Titanium
keywords: Calcium phosphate cement; Cerebrospinal fluid leak; Cranioplasty; Retromastoid craniectomy; Titanium mesh