Repair of skull defects using mesh supportedhydroxyapatite cement

Background: The search for an ideal material for cranioplasty has been a very difficult quest. Many materials have been advocated Hydroxyapatite seemed to gather many useful characteristics; it is safe and does not advocate any toxic or immune reactions. It also has the benefit of being both osteoconductive as well as biocompatible. However, hydroxyapatite was not popularly used due to the putty like consistency of the cement which leads to its settling. Objective: The aim of this study is to evaluate using a technique in which hydroxyapatite cement is applied to cranial defects ranging between 20-42cm 2 after reinforcement with polypropylene- polyester mesh. Methods: Fourteen patients with different ages with cranial defects of variable sizes due to different pathologies were included in this study. Hydroxyapatite cement was applied to the defect over the fashioned polypropylene-polyester mesh after exposure of the bony edges. Surgical results were then analyzed. Results: This technique was conducted on 14 cases of different pathologies; the cranioplasties ranged in size from 20 to 42 cm 2 (mean= 30.85 cm 2). Surgical results revealed a satisfactory cosmetic outcome in all cases with no report of infection or cerebrospinal fluid leak. Follow up ranged from 3-24 months (mean 12.9 months). Conclusion: The use of mesh supported hydroxyapatite cement proved to be a safe and convenient method in treating patients suffering skull defects of various etiologies providing good cosmetic result in addition to the simplicity in the technique.