Evaluation of the Use of Calcium Phosphate Cement for Aesthetic Neurosurgical Cranial Reconstruction

Objective The objective of this article is to evaluate whether newly developed calcium phosphate cement (CPC), mounted around the titanium plates, is useful for aesthetic cranial reconstruction by using 2 methods. Methods The morphologic changes of CPC were observed in videos of 6 patients who had undergone cranial reconstruction with CPC during the first surgery and required second surgery. The facial aesthetic outcomes of 74 consecutive patients, more than 12 months after frontotemporal or bifrontal craniotomy and reconstruction with or without CPC, were evaluated. Results Observations of CPC changes were available 1 day, 2 weeks, 2 months, 5 months, 10 months, and 26 months after the first surgeries. CPC, applied superficially on the cranial surface, had not set sufficiently. CPCs, mounted thickly around the titanium plates and forming hydroxyapatite, were residual during the latter period. Comparison between the aesthetic reconstruction group (with CPC) and the simple reconstruction group (without CPC) showed that the objective bump detected by the investigator, and the subjective bump noticed by the patients themselves, were significantly more frequent in the simple reconstruction group. Comparison between the patients without an objective bump and the patients with an objective bump during the follow-up period showed that the proportion of patients after aesthetic cranial reconstruction with CPC was significantly higher in patients without an objective bump. Patients' characteristics, craniotomy procedure, use of a vascularized pericranial flap, and craniotomy-associated complications did not influence the objective bump significantly. Conclusions Use of CPC was expected to bring better aesthetic outcomes after neurosurgical cranial reconstructions.