Outcomes of Calvarial Reconstruction in Cancer Patients

Background: Limited data exist on outcomes of calvarial reconstruction in cancer patients, including the relative efficacy of various cranioplasty materials, and risk factors for complications. Methods: A retrospective review was performed of cancer patients who underwent calvarial reconstruction over a 12-year period. Results: A total of 269 patients underwent 289 calvarial reconstructions. Materials used for cranioplasty included titanium mesh (49.8 percent), methylmethacrylate (16.3 percent), porous polyethylene (4.8 percent), polyetheretherketone (4.5 percent), calcium phosphate cement (3.8 percent), autologous bone grafts (2.1 percent), or a combination of materials (18.3 percent). Perioperative (⩽30 days after surgery) complications occurred in 42 cases (14.5 percent), of which 29 (10.0 percent) were at the recipient site, most commonly infection (2.8 percent) and cerebrospinal fluid leak (2.4 percent). Risk factors for perioperative complications included radiation therapy (p = 0.012), prior surgery (p = 0.003), and prior infection (p = 0.014). Late recipient-site complications (>30 days after surgery) occurred in 20 cases (6.9 percent), including infection (3.8 percent) and wound dehiscence (3.1 percent), and for which radiation therapy was identified as a risk factor (p = 0.011). The use of calcium phosphate cement in combination with titanium mesh was associated with a higher long-term complication rate (p < 0.001). Twenty-five cases (8.7 percent) required cranioplasty removal, with infection and dehiscence being risk factors for implant loss (p < 0.001 for both). Conclusions: Alloplastic cranioplasty is effective in cancer patients with calvarial defects. Commonly used materials have similar complication profiles, with the possible exception of calcium phosphate cement, which is associated with a higher rate of complications when combined with titanium mesh and used to reconstruct larger defects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.