Epidural Fluid Collection after Cranioplasty using Hydroxyapatite Ceramics following Bone Cement

Abstract

Hydroxyapatite ceramics (HAC) have not caused any foreign body reactions in clinical cases due to its high affinity to bone. A 45-year-old male underwent surgery for parietooccipital parasagittal meningioma. After total removal, LYODURA^[○!R] (10×12cm) was used as a substitutive dura mater, and bone cement CEMEX^<TM> was used instead of the removed bone flap since they had been invaded by a tumor. Subcutaneal effusion appeared 4 months later. HAC-made bone-plate (10×8cm) was set after removal of the CEMEX^<TM> bone-plate. Nevertheless, distinctive epidural-subcutaneal effusion reappeared 1 month later. The 3rd operation was performed to remove the HAC bone-plate after 2 more months. Clear effusion (120ml) was pooling. No leakage of cerebrospinal fluid throught substitutive dura was seen. The effusion was thought to be derived from foreign body reaction because there was no sugar in the constituent. When a skull defect is wide, previous use of bone cement may produce fluid collection even in HAC applied cases.