Abstract
This work aimed at investigating the possibility and effectiveness of osteoinductive calcium phosphate (CaP) ceramics to close the drilled skull holes and prevent the postoperative cerebrospinal fluid (CSF) leaking in children’s endoscopic neurosurgery. Five children patients (four boys and one girl, 3- to 8-years old) underwent the surgery, in which the endoscopic third ventriculostomy (ETV) was operated in four cases of hydrocephalus, and biopsy and ETV were both performed in one case of pineal tumor. The drilled skull holes were filled with the commercial osteoinductive CaP ceramics. The patients were followed up by CT scan at 1, 7 days, 3 and 6 months postoperatively. All the five cases were successful, and the holes were closed well after filled with the ceramics. The follow-up survey showed that no CSF leaking or rejection reaction was found. The CT scan indicated that the drilled holes began healing at 7 days postoperatively, and a relatively complete healing happened at 6 months postoperatively. The excellent ability of the CaP ceramics to induce bone regeneration was also confirmed by repairing the skull defects in a monkey model. The results of μ-CT and histological analysis showed that a bony structure with irregular array occurred at the defect area, and the newly formed bone volume density reached 65.7%. In conclusion, the osteoinductive CaP ceramics could be an ideal material to treat the drilled skull holes in children’s endoscopic neurosurgery and prevent CSF leaking afterwards. However, further investigation with more cases and longer follow-up was required to evaluate the clinical effect.
Highlights
Neuroendoscopy is one of the most important surgical managements in minimally invasive neurosurgery [1, 2]
It is undefined how to deal with the drilled skull holes due to the endoscopic surgery, and inappropriate treatment may lead to cerebrospinal fluid (CSF) leaking, especially in infants and young children [8,9,10]
Since Mixter performed the first case of endoscopic third ventriculostomy (ETV) in 1923, neuroendoscopy was used in the management of hydrocephalus and got a full development later on
Summary
Neuroendoscopy is one of the most important surgical managements in minimally invasive neurosurgery [1, 2] With technological advance, this surgical technique has been adapted to children [3,4,5,6,7]. It is undefined how to deal with the drilled skull holes due to the endoscopic surgery, and inappropriate treatment may lead to cerebrospinal fluid (CSF) leaking, especially in infants and young children [8,9,10]. Due to the existence of the cortex track communicating with ventricle, as well as the limited size of the drilled skull hole, the hard mask is hard to be sutured, leading to the permanent existence of the CSF leaking. Otherwise the persistent CSF leaking could induce the incision or even the intracranial infection
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