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P244: OUR 30 YEAR EXPERIENCE UTILIZING HYDROXYAPATITE CEMENT (HAC) IN CRANIAL SURGERY: APPLICATIONS, OUTCOMES, AND CONSIDERATIONS
Justin Cottrell; Khaled Alok; Jennifer Moliterno; John Kveton; Yale University

Objectives: To reflect upon and disseminate practical takeaways from our study center’s experience utilizing Hydroxyapatite Cement (HAC) for over 30 years, in over 100 patients, in the reconstruction of retrosigmoid and translabyrinthine defects following vestibular schwannoma resection.

Design: Single centre outcome review, with a special focus on procedural adaptations over time to improve success. 

Setting: Tertiary referral center.

Participants: Patients undergoing retrosigmoid or translabyrinthine approach to vestibular schwannoma resection that had HAC reconstruction. 

Main Outcome Measures: Rates of CSF leak, pseudomeningocele, infection, and HAC resorption

Results: HAC has been a reliable reconstructive method for decades at our centre. For retrosigmoid defects, early experience demonstrated no CSF leaks, although HAC resorption was noted before technical adjustments and incorporation of a post-operative drain. No pseudomenginoceles have been reported.  For translabyrinthine defects, early experience demonstrated a low rate of CSF leak (3.8%), and acceptable rate of infection (5.8%). Our technique has evolved over the years to address earlier pitfalls, leading to improved outcomes which will be discussed. No pseudomeningoceles have been reported.

A focus on procedural steps and pearls that surgeons can use if interested in incorporating HAC into their armamentarium will be provided. Examples include how to adequately seal off the temporal bone from CSF leakage, protecting the cochlear nerve, ensuring an excellent match to pre-operative bone contours, and encouraging osteoblast activity. A step-by-step approach to both retrosigmoid (Figure 1) and translabyrinthine (Figure 2) reconstruction utilizing our refined technique will be provided in this talk.

Conclusions: HAC is a reliable and practical material for reconstructing retrosigmoid and translabyrinthine skull base defects. Its ability to integrate with bone, reduce the need for autologous grafts (and resulting scar/complications), and effectively seal makes it a valuable tool in modern neurosurgical practice when careful patient selection and proper procedural technique is employed.  

Figure 1

Figure 2

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