Does the Use of a Jackson-Pratt Drain following Cranioplasty with Titanium Mesh and Hydroxy Apatite Decrease the Rate of Cranioplasty Complications?

Objective : The use of hydroxyapatite and titanium mesh is a valuable reconstruction method for craniotomy defects following skull base surgery. We report the utility of intraoperative placement of a Jackson-Pratt to prevent breakdown of hydroxyapatite cement in reconstruction craniotomy. Study Design : Retrospective study Setting-Tertiary University and Private Hospitals Subjects and Methods : Cases of skull base operations between the years 2006–2010 were studied at two different hospital settings but performed by a single surgeon. Medical records were reviewed for the following data: type of cranioplasty reconstruction, intraoperative drain placement, perioperative complications related to the wound, and cranioplasty revisions Results : Preliminary data suggests that of the 179 subjects who had skull base operations 16 needed further revision of the hydroxyapatite and titanium mesh. The patients who necessitated revision included 7 for debridement of infection, 3 due to fistula formation, 2 for hematoma formation, and 1 for CSF leak, recurrence, and hydroxyapatite breakdown respectively. There were 5 subjects that required revisions that did not have intraoperative drain placement. There were 11 patients received intraoperative drain placement. The incidence of revision for those patients receiving intraoperative drain placement was found to be 9.6 patients/100 patients and those who did not have drain placement had an incidence of 7.7 patients/ 100 patients. Conclusions : Intraoperative drain placement does not appear to affect the number of revisions following cranioplasty with hydroxyl apatite and titanium mesh. The use of hydroxyapatite cement to restore cranial bone integrity has shown excellent results; however, the use of a drain to allow the hydroxyapatite to prevent breakdown has not previously studies. Cranial base reconstruction has been accomplished for translabyrinthine, middle cranial fossa, and retrosigmoid approach. Previous studied suggest that exposure to cerebrospinal fluid does not appear to alter its stability, and pre-existing infection appears to be the only contraindication to its use.