Early osteointegration in “one-step” resection and reconstruction using porous hydroxyapatite custom implants for skull-infiltrating tumors: a monocentric prospective series

Background: Early reconstruction of the skull represents the gold standard after resection of bone infiltrating cranial tumors. Customized hydroxyapatite porous ceramics are an excellent option for covering skull bone defects. The authors illustrate the surgical technique and investigate the effectiveness of the "one-step" procedure in terms of aesthetic results and early degree of osteointegration. Method: A prospective study was conducted, including all patients operated on for skull bone infiltrating lesions at our center between January 2020 and June 2022. Stereolithography was the technique used for shaping the epoxy-resin model, suitable for both designing the craniotomy and manufacturing the custom-made hydroxyapatite prosthesis. Clinical outcome, results of early (6-week) and late (3-month) osteointegration evaluated on CT and MRI, and level of patient satisfaction measured by the FACE-Q questionnaire were reported. Results: Fourteen patients (13 adults and a 7-year-old boy) and a total of 15 implants were included. The average percentage of early osteointegration calculated at the edge of the prosthesis, was 72.2%, that increased to 82.6% after 3 months. Patient-reported outcomes indicated a high level of satisfaction across all patients. Conclusions: "One-step" resection and reconstruction using customized hydroxyapatite porous implants for treatment of skull infiltrating tumors is a safe, simple and effective technique, in particular when the bone defect is large. Bone regeneration around and inside the prosthesis seems to start early after surgery.