title: Hydroxyapatite cement cranioplasty following translabyrinthine approach: Long-term study of 369 cases.
abstract: To report the authors' experience with hydroxyapatite cement (HAC) cranioplasty and analyze the material's long-term safety and efficacy in repairing translabyrinthine skull-base defects by examining adverse events, specifically cerebrospinal fluid (CSF) leaks and surgical site infections.
  
  
  
  Retrospective case-control study (primary study arm); prospective cross-sectional study of patients not examined within the last 5 years (secondary arm).
  
  
  
  tertiary-care neurotology private practice and academic practice (two centers).
  
  
  
  Hydroxyapatite cement implanted following translabyrinthine approach, with or without fat graft, was included. Combined approaches were excluded. Implant-associated adverse events were defined as 1) CSF leaks requiring reoperation or spinal drainage, and (2) infections requiring reoperation. Patients not examined within 5 years were interviewed by telephone to update their condition. Incidence of adverse events was compared to published data for translabyrinthine cranioplasty using fat graft alone. Implant survival analysis was performed.
  
  
  
  The study cohort included 369 HAC implants in the same number of patients. There were seven CSF leaks and seven infections. Combined (n = 14) incidence of adverse events was 3.8% (2.09%, 6.28%). Compared to fat graft alone, the adverse events associated with HAC were fewer (P < 0.001). Up to 15 years (5,475 days), HAC cement maintained 95% adverse event-free survival. There were no cases of meningitis.
  
  
  
  Cranioplasty using HAC with autologous fat following translabyrinthine skull-base surgery is safer and more effective than fat graft alone, up to 15 years after surgery.
  
  
  
  4. Laryngoscope, 127:2120-2125, 2017.
authors.affiliation: Pittsburgh Ear Associates, Philadelphia, Pennsylvania.|Division of Otolaryngology, Philadelphia, Pennsylvania.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Volsky
authors.affiliation: Pittsburgh Ear Associates, Philadelphia, Pennsylvania.|Division of Otolaryngology, Philadelphia, Pennsylvania.|Allegheny Health Network, Pittsburgh, Philadelphia, Pennsylvania.|Department of Otolaryngology, Temple University, Philadelphia, Pennsylvania.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Hillman
authors.affiliation: Department of Otolaryngology, Temple University, Philadelphia, Pennsylvania.
authors.forename: Kellen J
authors.initials: KJ
authors.lastname: Stromberg
authors.affiliation: Division of Otolaryngology, Philadelphia, Pennsylvania.
authors.forename: Farrel J
authors.initials: FJ
authors.lastname: Buchinsky
authors.affiliation: Pittsburgh Ear Associates, Philadelphia, Pennsylvania.|Allegheny Health Network, Pittsburgh, Philadelphia, Pennsylvania.|Department of Otolaryngology, Temple University, Philadelphia, Pennsylvania.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology, Western Reserve Hospital, Cuyahoga Falls, Ohio.
authors.forename: Neal M
authors.initials: NM
authors.lastname: Jackson
authors.affiliation: Department of Otolaryngology, Baton Rouge, Louisiana.|Neurosurgery, Baton Rouge, Louisiana.|Louisiana State University New Orleans, Baton Rouge, Louisiana.|CNC Hearing and Balance Center, New Orleans, Baton Rouge, Louisiana.|Our Lady of the Lake Hearing and Balance Center, Baton Rouge, Louisiana.
authors.forename: Moisés A
authors.initials: MA
authors.lastname: Arriaga
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D016022:Case-Control Studies; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods; D003430:Cross-Sectional Studies; D007758:Ear, Inner / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D006882:Hydroxyapatites / Q000009:adverse effects*; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
chemical_list: D006882:Hydroxyapatites; C475044:hydroxyapatite cement
keywords: Skull base; acoustic neuroma; biocompatible materials; cerebrospinal fluid; craniotomy; hydroxyapatites; long-term adverse effects; wound closure techniques