Long-Term Follow-Up Experience with Carbonated Calcium Phosphate Cement (Norian) for Cranioplasty in Children and Adults
Bibliographic record
Abstract
BACKGROUND: Despite the growing popularity of calcium-based bone cements as a cranioplasty material, the long-term success and complication rates of these materials remain largely controversial. The authors reviewed their extended experience with Norian, a carbonated calcium phosphate bone cement, for cranioplasty. METHODS: A retrospective chart review of all patients who underwent cranioplasty using Norian over the past 9 years was conducted. Patients with less than 1 year of follow-up were excluded. RESULTS: Forty-six patients were studied. Follow-up averaged 43.9 months (range, 12.1 to 109.8 months). The overall complication rate was 26 percent, and included infection (n = 9), seroma (n = 1), or a chronically draining sinus (n = 2). Average time to onset of a complication was 20.2 months (range, 2.3 to 89.2 months). Two of nine infections resolved with oral antibiotics; the remaining complications required surgical intervention for definitive treatment. Factors associated with a statistically increased risk of complications were amounts of Norian used (p < 0.01) and onlay application with a high probability for bacterial contamination (p = 0.001), whereas reconstruction of full-thickness cranial defects larger than 25 cm trended toward worse outcomes (p > 0.05). CONCLUSIONS: Norian is well suited for cranioplasty when used in moderate amounts for onlay applications, as evidenced by acceptable complication rates and contouring ability in this setting. Its use in large amounts as an onlay, inlay full-thickness cranial reconstruction of large defects or areas with potential bacterial contamination should be avoided. Complications or construct failure may occur months or even years after implantation, even under ideal circumstances.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".