Polymethylmethacrylate Cranioplasty in Lateral and Posterolateral Skull Base Approaches: Long-Term Results of 107 Cases

Introduction: The benefits of a primary cranioplasty after lateral and posterolateral approaches are to minimize postoperative CSF leakage, headache, and deformity. Several techniques and materials are used for cranioplasty. Polymethylmethacrylate (PMMA) is generally the most frequently used material with a reported high rate of graft infection.

Methods: Over 10 years, from 1998 to 2007, primary cranioplasty of lateral and posterolateral approaches with partial or complete mastoidectomy was performed for 107 cases at the University Department of Neurosurgery, in Usti nad Labem. PMMA with gentamicine was used in all cases. The mean postoperative follow-up period was 226 weeks. Age distribution of patients ranged from 18 to 81 years. The cases comprised 61 females and 46 males.

Results: We did not experience any case of a bone graft infection or the PMMA graft removal (0%). There were only three complications requiring further therapy (2.8%). The first patient had a subcutaneous CSF collection and a secondary purulent meningitis due to prolonged lumbar drainage and required surgical revision with duraplasty without PMMA removal. The second patient, after resection of a large vestibular schwannoma with CSF leakage through the lamina cribrosa, was treated by VP shunt insertion. The last patient with CSF leakage after a facial nerve reconstruction surgery was successfully treated with a lumbar drainage.

Conclusion: PMMA with gentamicine is a cost-effective material with a very low rate of complication in the reconstruction of defects after lateral and posterolateral approaches.