Hydroxyapatite cement cranioplasty following translabyrinthine approach: Long-term study of 369 cases

Laryngoscope. 2017 Sep;127(9):2120-2125. doi: 10.1002/lary.26403. Epub 2017 Jan 6.


Objective: To report the authors' experience with hydroxyapatite cement (HAC) cranioplasty and analyze the material's long-term safety and efficacy in repairing translabyrinthine skull-base defects by examining adverse events, specifically cerebrospinal fluid (CSF) leaks and surgical site infections.

Study design: Retrospective case-control study (primary study arm); prospective cross-sectional study of patients not examined within the last 5 years (secondary arm).

Setting: tertiary-care neurotology private practice and academic practice (two centers).

Methods: Hydroxyapatite cement implanted following translabyrinthine approach, with or without fat graft, was included. Combined approaches were excluded. Implant-associated adverse events were defined as 1) CSF leaks requiring reoperation or spinal drainage, and (2) infections requiring reoperation. Patients not examined within 5 years were interviewed by telephone to update their condition. Incidence of adverse events was compared to published data for translabyrinthine cranioplasty using fat graft alone. Implant survival analysis was performed.

Results: The study cohort included 369 HAC implants in the same number of patients. There were seven CSF leaks and seven infections. Combined (n = 14) incidence of adverse events was 3.8% (2.09%, 6.28%). Compared to fat graft alone, the adverse events associated with HAC were fewer (P < 0.001). Up to 15 years (5,475 days), HAC cement maintained 95% adverse event-free survival. There were no cases of meningitis.

Conclusion: Cranioplasty using HAC with autologous fat following translabyrinthine skull-base surgery is safer and more effective than fat graft alone, up to 15 years after surgery.

Level of evidence: 4. Laryngoscope, 127:2120-2125, 2017.

Keywords: Skull base; acoustic neuroma; biocompatible materials; cerebrospinal fluid; craniotomy; hydroxyapatites; long-term adverse effects; wound closure techniques.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adipose Tissue / transplantation
  • Case-Control Studies
  • Cerebrospinal Fluid Leak / epidemiology
  • Cerebrospinal Fluid Leak / etiology
  • Cerebrospinal Fluid Leak / surgery
  • Craniotomy / adverse effects*
  • Craniotomy / methods
  • Cross-Sectional Studies
  • Ear, Inner / surgery*
  • Follow-Up Studies
  • Humans
  • Hydroxyapatites / adverse effects*
  • Incidence
  • Plastic Surgery Procedures / adverse effects*
  • Plastic Surgery Procedures / methods
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / surgery
  • Prospective Studies
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Skull Base / surgery
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / surgery
  • Transplantation, Autologous / methods
  • Treatment Outcome


  • Hydroxyapatites
  • hydroxyapatite cement