Titanium mesh and hydroxyapatite cement cranioplasty: a report of 20 cases.

PURPOSE This article describes the use of titanium mesh and hydroxyapatite cement constructs for the treatment of large through-and-through calvarial defects. PATIENTS AND METHODS Twenty consecutive calvarial defects (10 to 156 cm(2)) that resulted from surgical removal of neoplasms or were secondary to trauma were reviewed retrospectively after reconstruction with titanium mesh and hydroxyapatite cement. All patients were followed up by clinical examination and periodic radiographic studies for a minimum of 6 months (range, 6 months to 3 years). Three patients underwent biopsy of the construct at various points during their follow-up. RESULTS There was no evidence of adverse healing, wound infection, or implant exposure or extrusion in any of the patients reviewed. Adequate 3-dimensional aesthetic restoration of calvarial contour was noted in each case. There was evidence of osseous ingrowth into the titanium mesh and hydroxyapatite cement construct in all 3 patients who underwent biopsy. CONCLUSION Titanium mesh and hydroxyapatite cement cranioplasty appears to be a reasonable method for the reconstruction of significant calvarial defects.