S241 – Acoustic Neuroma Surgery: Hydroxyapatite Cement Cranioplasty

Abstract

Objectives

To review the outcome of hydroxyapatite cement cranioplasy in acoustic neuroma surgery using trans-labyrinthine and retrosigmoid approaches.

Methods

Retrospective chart review of the cases of acoustic neuroma resection performed in our institution from January 1, 2007, until November 1, 2007, using 2 separate types of hydroxyapatite cranioplasty in wound closure. Abdominal fat graft in case of translabyrinthine approach and either abdominal fat graft or duragen were covered using Hydrset (Stryker) or Bonesouce (Stryker) hydroxyapatitie cement bone substitute. Translabyrinthine and Retrosigmoid resections were included in the review. The rate of postoperative cerebrospinal fluid leak, lumbar drain use, and early wound complications were recorded.

Results

There were 33 cases of acoustic neuroma resection over a period of 10 months using hydroxyapatite cranioplasty. Hydroset bone substitue was used in 16 cases and no CSF leak was observed. Bonesource bone substitute was used in 17 cases and 1 case of CSF leak was observed. The leak was managed with lumbar drain placement and resolved without any additional interventions. In the Hydroset group no drains were used, and in the Bonsource group drains were placed at the completeion of a procedure and removed 12 hours postoperatively. There were no wound complications seen at the completeion of the review. No other adverse outcomes were noted.

Conclusions

Both forms of hydroxyapatite cranioplasty are reliable methods to avoid CSF leak in acoustic neuroma surgery. The handling characteristics and no need for drain with Hydroset may make it preferable as a bone reconstruction technique in acoustic neuroma surgery.