Recent experience with calcium phosphate cement cranioplasty after lateral supraorbital keyhole approach to the anterior cranial fossa.

Abstract

Objective: Through an eyebrow incision, the lateral supraorbital (LSO) keyhole approach provides access to various lesions in the anterior cranial fossa and affords many of the advantages of minimal access and minimally invasive surgery. The LSO approach and other minimal access approaches including various endonasal approaches to the anterior cranial fossa, however, have been associated with nonnegligible rates of CSF leaks postoperatively. The authors report their recent experience using calcium phosphate cement cranioplasty as a method of preventing CSF leakage after LSO keyhole craniectomy.

Methods: A retrospective medical records review was performed for 9 consecutive patients undergoing operations by the senior authors using the LSO keyhole approach with skull defect repair using calcium phosphate cement cranioplasty alone between 2022 and 2024. Review of the medical records included clinic notes, imaging studies, and operative notes as well as details regarding the length of hospital stay, complications, and rate of tumor recurrence.

Results: Eight of 9 patients underwent resection of meningiomas, while 1 underwent resection of a cavernous malformation. The cohort consisted of 7 females (78%) and 2 males (22%) with a mean age of 55.2 years. The mean tumor volume among the 8 meningiomas was 18.09 cm3, and peritumoral edema was present in 8 of the 9 cases (89%). Gross-total resection was achieved in 7 of 8 meningioma cases (87.5%). Among the 9 patients, the mean length of hospital stay was 2.4 days. Two patients (22%) experienced complications. No patients experienced a CSF leak postoperatively. At a mean follow-up of 13.8 months, 1 patient (12.5%) experienced tumor recurrence.

Conclusions: Based on this and prior experience, the use of calcium phosphate cement cranioplasty alone following an LSO keyhole approach to the anterior cranial fossa is a safe alternative to traditional closure techniques, which rely on replacement of bone flap with plates and screws, and it might reduce the rate of postoperative CSF leakage. Larger studies are required to confirm these findings.