Kitano Masahiko, Taneda Mamoru
Department of Neurosurgery, Kinki University School of Medicine, Osaka, Japan.
Neurosurgery. 2007 Sep;61(3 Suppl):E53-4; discussion E54. doi: 10.1227/01.neu.0000289713.80178.ce.
Injectable hydroxyapatite cement (HAC, Biopex; Mitsubishi Pharma Corp., Osaka, Japan) can reconstruct the accurate contour of bone defects intraoperatively, and it is slowly replaced with bone by a process of resorption and osteoconduction, making it a useful substrate for the repair of cranial defects. In the operative site with continuous oozing of the cerebrospinal fluid, however, the implanted HAC may be dissolved and washed out as a result of its water solubility during the setting time. For successful reconstruction of cranial defects in such wet situations, we describe a new technique to reinforce the implanted HAC with a multilayered application.
As a preliminary experiment, we observed that the setting process of the HAC was severely restricted by the environmental temperature. At a temperature of 5 degrees C, the initial setting time of the HAC could be extended to 10 hours after the beginning of the mixing of the HAC. Bone defects of the sellar floor after transsphenoidal surgery for pituitary adenomas, craniopharyngiomas, meningiomas, or suprasellar arachnoid cysts were reconstructed using the HAC in 55 patients during a 5-year period. The results and complications were obtained through retrospective review.
Ninety-eight percent of bone defects were successfully repaired using the HAC, and the reconstruction remained stable over the course of this study. There was one case of postoperative cerebrospinal fluid leakage. Wound infection occurred in one patient, which required reoperation and removal of the biomaterial.
The icing and multilayering method for proper use of this biomaterial resulted in restoration of the integrity of the cranial base bone and a decrease of cerebrospinal fluid leakage as a postoperative complication of transsphenoidal surgery. HAC is a biomaterial that is recommended to be used as the primary method for reconstructing cranial base bone defects.
可注射羟基磷灰石骨水泥（HAC，Biopex；日本大阪三菱制药公司）能够在术中重建骨缺损的精确轮廓，并且通过吸收和骨传导过程被骨组织缓慢替代，使其成为修复颅骨缺损的有用材料。然而，在脑脊液持续渗漏的手术部位，植入的HAC在凝固期可能因其水溶性而溶解并被冲洗掉。为了在这种潮湿情况下成功重建颅骨缺损，我们描述一种通过多层应用来加固植入HAC的新技术。
作为初步实验，我们观察到HAC的凝固过程受到环境温度的严重限制。在5摄氏度的温度下，HAC的初始凝固时间可延长至开始混合HAC后的10小时。在5年期间，对55例因垂体腺瘤、颅咽管瘤、脑膜瘤或鞍上蛛网膜囊肿行蝶鞍手术的患者，使用HAC重建蝶鞍底骨缺损。通过回顾性分析获得结果及并发症情况。
98%的骨缺损使用HAC成功修复，并且在此研究过程中重建保持稳定。有1例术后脑脊液漏。1例患者发生伤口感染，需要再次手术并取出生物材料。
正确使用这种生物材料的冰敷和多层应用方法可恢复颅底骨的完整性，并减少蝶鞍手术术后脑脊液漏这一并发症。HAC是一种推荐用作重建颅底骨缺损主要方法的生物材料。
