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Outcomes of Calvarial Reconstruction in Cancer Patients

Lee, Edward I. M.D.; Chao, Albert H. M.D.; Skoracki, Roman J. M.D.; Yu, Peirong M.D.; DeMonte, Franco M.D.; Hanasono, Matthew M. M.D.

Plastic and Reconstructive Surgery: March 2014 - Volume 133 - Issue 3 - p 675–682
doi: 10.1097/01.prs.0000438061.46290.33
Reconstructive: Head and Neck: Original Articles

Background: Limited data exist on outcomes of calvarial reconstruction in cancer patients, including the relative efficacy of various cranioplasty materials, and risk factors for complications.

Methods: A retrospective review was performed of cancer patients who underwent calvarial reconstruction over a 12-year period.

Results: A total of 269 patients underwent 289 calvarial reconstructions. Materials used for cranioplasty included titanium mesh (49.8 percent), methylmethacrylate (16.3 percent), porous polyethylene (4.8 percent), polyetheretherketone (4.5 percent), calcium phosphate cement (3.8 percent), autologous bone grafts (2.1 percent), or a combination of materials (18.3 percent). Perioperative (≤30 days after surgery) complications occurred in 42 cases (14.5 percent), of which 29 (10.0 percent) were at the recipient site, most commonly infection (2.8 percent) and cerebrospinal fluid leak (2.4 percent). Risk factors for perioperative complications included radiation therapy (p = 0.012), prior surgery (p = 0.003), and prior infection (p = 0.014). Late recipient-site complications (>30 days after surgery) occurred in 20 cases (6.9 percent), including infection (3.8 percent) and wound dehiscence (3.1 percent), and for which radiation therapy was identified as a risk factor (p = 0.011). The use of calcium phosphate cement in combination with titanium mesh was associated with a higher long-term complication rate (p < 0.001). Twenty-five cases (8.7 percent) required cranioplasty removal, with infection and dehiscence being risk factors for implant loss (p < 0.001 for both).

Conclusions: Alloplastic cranioplasty is effective in cancer patients with calvarial defects. Commonly used materials have similar complication profiles, with the possible exception of calcium phosphate cement, which is associated with a higher rate of complications when combined with titanium mesh and used to reconstruct larger defects.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Houston, Texas

From the Departments of Plastic Surgery and Neurosurgery, The University of Texas M. D. Anderson Cancer Center.

Received for publication June 10, 2013; accepted September 17, 2013.

Disclosure: The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article. No funding was received for this work.

Matthew M. Hanasono, M.D., Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 443, Houston, Texas 77030, mhanasono@mdanderson.org

©2014American Society of Plastic Surgeons