Methods: In situations where dural herniation or dural pulsation prevent the cement from maintaining its original contour, we obtain a circulferential exposure of the dura from the overlying bone, and the Lactosorb sheet is placed between the endocranial side of the bony defect and the dura itself. In the case of dural tears that cannot be primarily repaired or because of the shape of the calvarium at the repair site, we place the hydroxyapatite cement directly into the cranial defect over the dura, and affix the Lactosorb sheet to the surrounding normal bone with Lactosorb plates and screws.

Results: We have found the use of hydroxyapatite cement in concert with Lactosorb sheets to be useful in repair of cranial defects where there is some concern about movement of the cement. The Lactosorb sheet is effective when placed on either the endocranial or the epicranial side.

Conclusions: The combined use of hydroxyapatite cement for reconstruction of cranial bony defects along with the Lactosorb sheet for containment purposes has allowed a greater flexibility in the repair of these sometimes difficult defects. Over a period of 9-12 months, the Lactosorb sheet will be completely resorbed (as well as Lactosorb plates and screws, if used), leaving the repair matrix optimally situated with good aesthetic outcome.