Bone Cement Cranioplasty
Q: Dr. Eppley, I am interested in a bone cement cranioplasty. You have previously told me that it would not be good idea to try and remove the titanium mesh. Maybe you can walk me a little through this. I thought the titanium mesh was placed above the hole in my head and mounted with screws in the skull. I don’t see how my dura could be teared when unscrewing the screws and lifting of the titanium mesh? Has the dura grown into the mesh?
According to bone cement, is there any specific one you would recommend or would any product do the trick? Its just that it is a somewhat bigger cranial defect, but maybe that doesn’t have anything to say? And will the bone cement attach to the mesh, and surrounding bone, holding it in place?
Thanks for your time!
A: Since I assume you have never performed skull surgery, it would be understandable why you would not know that scar tissue and dura adhesions have occurred into the mesh which is certainly not a smooth surface. While it can be removed there is a significant risk of dural tears and a postop CSF leak in doing so. It simply is not a risk that most patients and surgeons would take when the original problem has been solved.
For a bone cement cranioplasty, hydroxyapatite cement would be the preferred coverage material and the size of the cranial contour problem is not an issue. The cement will adhere to both the bone and the metal material. Adherence of the cement is not an issue.
Dr. Barry Eppley