Evaluation of three different methods of cranioplasty; a comparative prospective randomized study

Abstract

BACKGROUND: Multiple materials have been used for cranioplasty with different pros and cons. The current literature is defective in studies comparing titanium mesh, polyetheretherketone (PEEK), and polymethyl methacrylate (PMMA).OBJECT: This prospective randomized study was conducted to compare the outcomes of three cranioplasty techniques; titanium mesh, PEEK, and PMMA, regarding the failure rates, the complications, and the patients' satisfaction. METHODS:A total of 84 cases were included, and they were randomly divided into three groups (28 cases in each group); titanium mesh, PEEK, and PMMA groups. All patients underwent proper preoperative evaluation, including history taking, neurological examination, and routine investigations. The operative time and postoperative complications were recorded. Our primary outcome was implant failure rates, whereas secondary outcomes included implant exposure, surgical site infection, graft resorption, postoperative new-onset seizures, extradural hemorrhage, and patient satisfaction.RESULTS: Age, gender, indication for cranioplasty, and operative time did not show any significant differences between the three groups. The prevalence of implant failure was 10.7%, 3.6%, and 14.3% in the titanium mesh, PEEK and PMMA groups, respectively. Although all complications (apart from extradural hemorrhage) tended to have a higher prevalence in the PMMA group, no significant difference was detected between the three groups regarding these complications. However, this lead to a significant decrease in patients' satisfaction in the PMMA group. CONCLUSION: Titanium mesh, PEEK, and PMMA have a comparable complication profile when used for cranioplasty. However, complication rates showed a slight increase with PMMA, which lead to decreased patient satisfaction.