Calcium Phosphate Cement “Space Fill-in” Augmentation in Autologous Cranioplasty for Large Cranial Defect: Additional Technical Consideration and Its Long-term Follow-up

In the skull tumor surgery that requires a large cranial reconstruction, economical one-time surgery is challenging. Calcium phosphate paste (CPC) alone is not applied in the large defect. Other plastic fill-in materials have each drawback. Ready-made implants are costly. The authors present additional technique of CPC cranioplasty combined with mainstay autologous grafts for a large cranial defect. The combination of split rib grafts was augmented by CPC. Tenons were placed for the stability of grafts. Our newly additional technique is that CPC is filled in the small adjacent spaces of autografts, not applied as the simple on-lay graft. We introduced this method to a 57-year-old gentleman with left parietal expansile skull tumor. The aesthetics of the patient has been satisfactory, and there were no complaints about pain in the graft site. In the follow-up period of 8 years, both autologous grafts and CPC were well maintained without marked resorption. This patient could work as a farmer in this period. Our methods fulfilled the requirements of aesthetics and in-situ plasticity for a larger cranial defect.