Surgical and Patient-Reported Outcomes in Patients With PEEK Versus Titanium Cranioplasty Reconstruction

Abstract

Background: Several materials are available for cranioplasty reconstruction and consensus regarding the ideal material is lacking. The goal of this study is to present surgical and patient-reported outcomes with PEEK versus Titanium alloplastic cranioplasty. Methods: A retrospective review of all patients who underwent alloplastic cranioplasty with PEEK or Titanium from 2010 to 2017 was conducted. Patient demographics and complications were abstracted and analyzed. Information regarding patient-reported outcomes was collected through a telephone survey. Results: A total of 72 patients (median age 55 years) who underwent 77 cranioplasties were identified (38% PEEK, n = 29; 62% Titanium, n = 48). Overall complication rates were similar between the PEEK (24%, n = 7) and Titanium groups (23%, n = 11), P = 0.902. Similarly, implant failure was similar between the 2 groups (7% in PEEK (n = 2), 13% in Titanium (n = 6), P = 0.703). History of radiation was associated with increased rate of infection in patients with Titanium mesh cranioplasty (38% in radiated patients (n = 3), 3% in nonradiated patients (n = 1), P = 0.012) but not PEEK implants (0% infection rate in radiated patients (n = 0), 15% in nonradiated patients (n = 4), P = 1.000). A total of 24 patients (33% response rate) participated in the telephone survey. All PEEK cranioplasty patients who responded to our survey (n = 13) reported good to excellent satisfaction, while 72% of our titanium mesh cohort (n = 8) described good or excellent satisfaction and 27% (n = 3) reported acceptable result. Conclusion: Cranial reconstruction is associated with high satisfaction among cranioplasty patients with PEEK or Titanium showing comparable complications, failure, and patient-reported satisfaction rates. Patients with history of radiotherapy demonstrated a higher infection rate when titanium mesh was used.

Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants

“…With advancements in AM systems, 3D printing of high-temperature thermoplastic polymers such as polyetheretherketone (PEEK) and prospects for customized FFF 3D-printed PEEK surgical implants have emerged, increasing attention for POC manufacturing [27][28][29]. Although milled PEEK implants have been used in cranial reconstructions for a long time [7,17,30], the commercial formulation of medical-grade PEEK filaments for extrusion-based 3D printing is relatively recent. By definition, any innovative technology is exploratory, and guidelines for using these novel approaches are needed to reduce the likelihood of errors [31].…”

Subgaleal Effusion and Brain Midline Shift After Cranioplasty: A Retrospective Study Between Polyetheretherketone Cranioplasty and Titanium Cranioplasty After Decompressive Craniectomy

“…Titanium is relatively cost-saving, and reduced operation time and intra-operative haemorrhage have been observed during covered cranioplasty with a titanium mesh ( 30 ) since the skull edge is not separated. However, a higher infection rate was found in patients with a history of radiotherapy who underwent titanium cranioplasty ( 15 ). Future exposure of the titanium mesh is another long-term complication with an incidence of 14% ( 22 ), necessitating reoperation and removal of the implant.…”

“…The polyaromatic semicrystalline polymer, PEEK, is commonly used as an implant material in spine reconstruction (12)(13)(14) and has been used in craniofacial reconstruction in recent decades (9,(15)(16)(17). Furthermore, PEEK is thermostable in the human body (18) and compatible with CT and MRI as it does not result in artefact formation (19).…”

“…Furthermore, PEEK is thermostable in the human body (18) and compatible with CT and MRI as it does not result in artefact formation (19). Compared with titanium mesh, it can provide a more aesthetic skull contour, adequate cerebral protection, and satisfactory imaging compatibility, with fewer complications (15,(20)(21)(22)(23). Compared with other polymeric materials, PEEK showed elasticity and tensile properties that mimic human bone and provided better protection during lab experiments (24).…”

The Use of the Three-Dimensional Printed Polyether Ether Ketone Implant in Secondary Craniosynostosis Revision

“…4 In contrast, titanium has an elastic modulus ten times higher than cortical bone, which can lead to bone resorption, and plate and implant loosening, an unwelcome complication in pedi-atric patients with preexisting bone irregularities. 10,22 As pediatric patients continue to grow and remodel their skulls, PEEK acts as an ideal material to ensure durability and neural protection.…”