Indications and Limitations of Carbonated Calcium Phosphate Cement for Secondary Contouring Cranioplasty: A Long-Term Institutional Experience.

Abstract

Abstract The authors describe our long-term institutional experience utilizing carbonated calcium phosphate (CCP) cement for secondary cranioplasty refinements with the goals to The authors conducted a retrospective cohort study of patients undergoing secondary cranioplasty for forehead reshaping utilizing CCP between June 2007 and August 2018. Exclusion criteria included < 3-month follow-up. The primary outcome was aesthetic forehead correction determined by Whitaker classification, while secondary outcomes included complications and reoperations. In total, 107 patients met inclusion with a median age of 15.5 years. The majority of bony deficits were limited to the frontal region (90.7%), required onlay application (87.7%) of large (96.0 cm2) partial thickness (85.7%) cranial defects, in a clean setting (99.0%), and ASA grade II (69.7%). Median Whitaker classification decreased from 2.3 [IQR: 2, 2.3] preoperatively to 1.0 [1.0, 1.3] postoperatively (P < 0.01). There was no difference in Whitaker classification between early and late postoperative timepoints (P < 0.17). The complication rate was 13.2%, with the majority related to infection (5/14). Factors associated with complications included frontal sinus proximity (OR 3.6, P < 0.04) and the use of interposition titanium mesh for full-thickness reconstruction (OR 6.4, P < 0.02). CCP remains an effective alloplastic bone substitute with a complication rate of 13.2% in patients undergoing secondary, onlay cranioplasty. Early postoperative Whitaker classification may predict long-term aesthetic results. Complications may arise years following implantation, warranting long-term follow-up.