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Biological Compatibility Profile on Biomaterials for Bone Regeneration
Published on: November 16, 2018
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Immediate CPAP Use after Skull Base Reconstruction with Hydroxyapatite Bone Cement.
Evan C Cumpston1, Ali H Sualeh2, Douglas J Totten1
1Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana.
Summary
Immediate continuous positive airway pressure (CPAP) use is safe after middle cranial fossa surgery for cerebrospinal fluid leaks. This approach is supported by robust bone cement repair, minimizing risks like pneumocephalus.
Area of Science:
- Neurosurgery
- Otolaryngology
- Sleep Medicine
Background:
- Resuming continuous positive airway pressure (CPAP) after skull base surgery is debated due to pneumocephalus risk.
- Spontaneous cerebrospinal fluid (sCSF) leaks in the middle cranial fossa (MCF) require effective surgical repair.
Purpose of the Study:
- To evaluate the safety of immediate postoperative CPAP use following MCF sCSF leak repair using bone cement.
Main Methods:
- Prospective cohort study involving 13 patients with temporal bone sCSF leaks and CPAP-dependent obstructive sleep apnea.
- Skull base repair utilized hydroxyapatite bone cement.
- CPAP was resumed on postoperative day 1 after CT confirmation of repair.
Main Results:
- No postoperative pneumocephalus or intracranial complications were observed.
- Postoperative CT scans confirmed no residual skull base defects.
- One patient experienced a contralateral sCSF leak two months post-surgery; no recurrent leaks occurred within one month.
Conclusions:
- Immediate postoperative CPAP initiation is safe for patients undergoing MCF sCSF leak repair with bone cement.
- The use of bone cement provides a robust repair, mitigating risks associated with CPAP use.
