Cranioplasty Using Polymethylmethacrylate Cement Following Retrosigmoid Craniectomy Decreases the Rate of Cerebrospinal Fluid Leak and Pseudomeningocele

Objective: Cerebrospinal fluid (CSF) leak frequently occurs after retrosigmoid craniectomy. The present study investigated the effects of cranioplasty using polymethylmethacrylate (PMMA) cement to reduce the incidence of CSF leak following retrosigmoid craniectomy as compared with the autologous bone flap combined with titanium plates. Methods: Two hundred forty-three patients underwent surgeries via retrosigmoid approach for microvascular decompression or tumor resection. Of these, 107 patients underwent craniotomy, and incomplete cranioplasty was performed with autologous bone flap fixed with titanium plates, while 136 patients underwent craniectomy and complete cranioplasty was performed with PMMA cement. Variables including the incidence of CSF leak, pseudomeningocele formation, wound infection, rejection reaction were compared retrospectively based on the clinical data between the 2 groups. Results: In the autologous bone group, 9 patients had postoperative CSF leaks, and 11 patients had pseudomeningoceles, while 3 CSF leaks and 2 pseudomeningoceles were found in the PMMA group. Statistical analysis showed that PMMA significantly decreased the incidence of postoperative CSF leaks (P = 0.03) and pseudomeningocele formation (P = 0.002). Wound infections were observed in 2 and 1 patients between the autologous bone and PMMA group, respectively, which did not differ significantly (P = 0.58). None of the patients in both groups developed a rejection reaction of artificial materials. Conclusions: Complete cranioplasty with PMMA cement following retrosigmoid craniectomy could decrease the incidence of CSF leak and pseudomeningocele formation as compared with the autologous bone flap combined with titanium plates. Thus, PMMA cement is preferable for bone reconstruction with excellent biocompatibility and without increasing the rate of wound infection. Address correspondence and reprint requests to Yili Chen, MD, PhD, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, China; E-mail: 3194086@zju.edu.cn Received 10 June, 2018 Accepted 31 October, 2018 This work was supported by the basic and public research project of Zhejiang province [grant numbers: LGF18H090010] and Yiwu Municipal Science and Technology Foundation of China [grant numbers: 2016-S-11]. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://bit.ly/2iuFjMi). © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2sVLUVe