A new technique for cranioplasty with L-shaped titanium plates and combination ceramic implants composed of hydroxyapatite and tricalcium phosphate (Ceratite)

OBJECTIVE: The use of hydroxyapatite-based ceramics for cranioplasties has recently increased in Japan, because of the good cosmetic outcomes, biocomp atibility, strength, osteoconductive properties, and lack of risk of diseas e transmission associated with these materials. However, miniplate fixation has not been possible for ceramic implants. We describe a new technique fo r miniplate fixation of ceramic implants. METHODS: Combination ceramic implants composed of hydroxyapatite and trical cium phosphate (Ceratite; NGK Spark Plug Co., Aichi, japan) were used for c ranioplasties. A slot and a pair of holes were cut in each Ceratite implant , for use as a fixation unit. We have also developed a new L-shaped titaniu m plate (HOMS Engineering Inc., Nagano, Japan) that fits into the fixation unit. We first insert an L-shaped titanium plate through the slot from the back surface of the Ceratite implant. We then bend the plate outward at the front surface of the Ceratite implant and fix it to the cranium of the pat ient with titanium screws. The Ceratite implant is usually firmly fixed to the cranium of the patient with three L-shaped titanium plates. RESULTS: Using L-shaped titanium plates and Ceratite implants, we successfu lly performed cranioplasties for seven patients with cranial defects result ing from external decompression craniotomies. The Ceratite implant exactly fit the bone window for each patient. Surgical maneuvers were simple and ea sy for all patients, permitting shorter operating times. All Ceratite impla nts were firmly fixed, and no postoperative infections have occurred. CONCLUSION: Our new technique for cranioplasty is simple and allows rigid f ixation of Ceratite implants.