Reconstruction of Cranial Base Defects Using the Medpor Titan Implant: Cranioplasty Applications in Acoustic Neuroma Surgery

Introduction: Reconstruction of cranial defects following skull base surgery is an essential step in structural and functional restoration, providing coverage and protection of intradural contents, minimizing and preventing postoperative cerebrospinal fluid (CSF) leaks, and attaining optimal cosmetic results. In acoustic neuroma surgery, cranioplasty of temporal bone defects minimizes postoperative CSF leakage by applying pressure to underlying fat grafts to block CSF egress (translabyrinthine approach), facilitates prevention of temporal hollowing (middle fossa approach), and reduces the incidence of postoperative headaches (retrosigmoid approach).

Methods: In this report, we describe a cranioplasty technique using an all-purpose sheet of the Medpor Titan implant for reconstruction of cranial defects after acoustic neuroma surgery. The Medpor Titan implant is a biocompatible material composed of a hybrid of titanium mesh embedded within two sheets of high-density porous polyethylene. We discuss the operative technique, surgical nuances, and applications to the major approaches for acoustic neuroma surgery.

Results: The Medpor Titan implant was used in 23 cranial reconstructions following acoustic neuroma resection. There were 10 male patients and 13 female patients with a mean age of 51.9 years (range, 38-69 years). The implant was used in 14 cases with a translabyrinthine approach, 8 cases with a retrosigmoid approach, and 1 case with a middle fossa approach. One patient in the translabyrinthine group had an incisional CSF leak requiring re-exploration and revision. There were no cases of pinna retraction, temporal hollowing, or implant infections. Mean follow-up time was 22.9 months (range, 1-48 months).

Conclusion: The Medpor Titan cranioplasty is a fast, efficient, and cost-effective method to reconstruct cranial defects after acoustic neuroma surgery. The implant is malleable yet rigid, easy to shape without sharp edges, and allows for ingrowth of bone and vasculature. The surgical nuances are illustrated in each of the three acoustic neuroma approaches including retrosigmoid, translabyrinthine, and middle fossa approach.