Utility of Bone Cement for Cranioplasty Following Retrosigmoid or Translabyrinthine Craniectomy: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background and objectives</h4>Translabyrinthine and retrosigmoid craniectomies carry high risk of wound complications. The goal of this study was to compare the effectiveness of bone cement versus no bone cement for translabyrinthine and retrosigmoid craniectomies in reducing the odds of cerebrospinal fluid (CSF) leaks, pseudomeningoceles, Surgical Site Infections (SSIs), and meningitis.  MATERIALS AND METHODS: A systematic review of the literature in databases was conducted for all relevant literature. Studies comparing outcomes of bone cement versus no bone cement use in adults undergoing retrosigmoid or translabyrinthine craniectomies were included. Bone cement group involved use of methylmethacrylate, calcium phosphate, or hydroxyapatite and non-bone cement - autologous bone, titanium mesh cranioplasty, or fat graft alone. Supratentorial or midline suboccipital craniectomies were excluded. Odds ratios (ORs) for outcomes with 95% confidence intervals (CIs) were calculated using the random-effects model.  RESULTS: From a total of 347 titles identified, 8 studies were chosen for analysis. There were a total of 1,044 and 1,021 patients in the cement and non-cement groups, respectively. In the retrosigmoid craniectomy cohort, bone cement was associated with lower odds of CSF leak (OR: 0.25 [CI: 0.14, 0.43], p<0.0001), pseudomeningocele (OR: 0.25 [CI: 0.14, 0.45], p<0.0001), SSI (OR: 0.27 [CI: 0.08, 0.98], p=0.05), and meningitis (OR: 0.13 [CI: 0.04, 0.45], p=0.001). There were no statistically significant differences in the translabyrinthine cohort.  CONCLUSIONS: Bone cement cranioplasty reduced the odds of CSF leaks, pseudomeningoceles, SSIs, and meningitis for retrosigmoid craniectomies and had equivalent outcomes for translabyrinthine craniectomies. This systematic review was based on retrospective cohort studies.