Wax on, wax off: a case report discussing a potential pitfall of dissolvable bone wax substitutes such as Ostene® in neurosurgery

Bone wax alternatives, such as Ostene®, are marketed as substitutes for traditional bone wax, offering the benefits of resorbability, improved bone osteogenesis, and reduced inflammatory reactions, granulomas, and infection risks. However, the limitations of these agents in cranial neurosurgery, particularly for sealing exposed air cells during skull base repair, are underreported. We present an early post-operative case of subcutaneous emphysema, pneumocephalus, and bone flap infection following the failure of Ostene® to provide a durable seal of air cells after temporal craniotomy and tumour resection. This highlights a limitation of Ostene® and other water-soluble bone haemostasis agents in cranial neurosurgery.