Comparison of Polyetheretherketone and Titanium Cranioplasty after Decompressive Craniectomy

Thien, Ady; King, Nicolas Kon Kam; Ang, Beng Ti; Wang, Ernest; Ng, Ivan

doi:10.1016/j.wneu.2014.06.003

Cited by 155 publications

(107 citation statements)

References 21 publications

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“…The core driving factor to the development of PEEK as a biomaterial was the need to balance strength and rigidity: to develop an implant system which met the structural strength requirements of the body, whilst minimizing rigidity in an attempt to reduce stress shielding risk [33,81]. Traditionally PEEK found use in spinal treatment applications, as well as cranial and maxillofacial applications [54,56,82].…”

Section: Discussionmentioning

confidence: 99%

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

et al. 2017

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Background: Analysis of current literature highlights a wide variation in reported infection risk for different materials in cranial repair. The purpose of these composite materials are to mimic natural bone and assist in restoring function (structurally and aesthetically) to the human skull. This review aims to examine the meta-data in order to provide an amalgamated overview of potential trends between implant material, manufacturing method and infection risk, in order to provide a core reference point for future studies surrounding emerging biomedical materials in the fields of cranioplasty by providing base point for understanding the capabilities and limitations of current technologies. Methods: A search for articles was conducted, with the following criteria seen as fundamental in providing an accurate picture of the current landscape: publication in the last decade, provision of a numerical value for both number of implants and infection cases, patient sample of 10+, adult patients, and cranioplasty/cranial repair. Results: A total of 41 articles were seen to meet the author's inclusion criteria. Average infection rates per material ranged between 2.04% and 10.98%. The results indicate that there is variation between materials in regards to total infection risk, however, depending on the materials compared, this value may be insignificant. Alternative risk factors associated with infection, including surgical time, revisions and previous infection, have a greater impact on infection potential than material variation. Comparison of fabrication methods did highlight a notable effect on average infection rate. Trends can be observed showing that materials with greater levels of surface interaction and active support of tissue ingrowth presented greater infection resistance. Such characteristics are due to the physical structures of the implants. Conclusions: It can be said that the manufacturing methods can influence biomedical materials to assist in minimizing implant infection risk.

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Section: Discussionmentioning

confidence: 99%

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

et al. 2017

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“…However, the long-term follow-up data of Thien showed that the total complication rate and failure rate of PEEK mesh group and titanium mesh group were 25.0% vs. 27.8% and 12.5% vs. 25% respectively, But his follow-up began after the operation of the decompression of the bone flap [13]. Another important factor to consider as implantation material is its biomechanical properties.…”

Section: Zhong/xie/liao/li/huangmentioning

confidence: 99%

“…It has a rate of up to 50% for total postoperative complication, meanwhile the donor site is susceptible to a trauma [11,12]. Titanium mesh skull repair has been introduced since 1965 and used until now, but limited by its elastic modulus and high thermal conductivity, uneven force distribution for mechanical impact after implantation, furthermore, has a rate of up to 27.8% of postoperative complications [13]. The cover-like titanium mesh skull repair has many shortcomings in clinical practice: 1) Titanium mesh size and shape does not match defect area; 2) There will be many re-shaping's of titanium mesh during operation thus will destroy its integrity and mechanical properties; 3) To make titanium mesh fit more solid without any buckling, there will be more titanium nails needed thus will increase the cost of treatment; 4) After surgery, it is prone to be deformation of titanium mesh, displacement, fracture, titanium wire exposure, nails loosen caused by force and other risks, leading to infection thus need to remove the titanium mesh again for a second repair.…”

Section: Introductionmentioning

confidence: 99%

Clinical application of triangular parabolic PEEK mesh with hole button produced by combining CAD, FEM and 3DP into cranioplasty

Zhong¹,

Xie²,

Liao³

et al. 2018

biomedicalresearch

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Background: Cranioplasty (CP) helps to restore the integrity of the skull and the stability of the inner brain structure, to greatly improve the aesthetic and to reduce the concerns caused by the weakening of the brain's protection. However, how to achieve less complications while maintain a high aesthetic effect of CP has always been the pursuits of the neurosurgeons, manufactures and researchers.

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“…4,5) However, titanium implants may be associated with a significant rate of complications, most commonly infection, and re-operation was sometimes necessary. [6][7][8][9] Exposed implant is an important but less understood complication which can lead to both infection and cosmetic problems.…”

Section: Introductionmentioning

confidence: 99%

“…7,8) The exposed implant rate in titanium cranioplasty was recently reported as 13.9% (15 of 108 cases). 9) That series included cases of moderate to large supratentorial skull defect resulting from operations such as decompressive craniectomy after trauma or stroke. Cranioplasty of the retrosigmoid approach has been evaluated, [10][11][12] during the operation.…”

Section: Introductionmentioning

confidence: 99%

Exposure of Titanium Mesh after Cranioplasty for Microvascular Decompression Surgery: Two Case Reports

Watanabe

Amagasaki

Naemura

et al. 2015

NMC Case Report Journal

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but the complications of titanium cranioplasty for small skull defect caused by the lateral suboccipital approach, particularly microvascular decompression (MVD) surgery, have not been investigated.From April 2008 to November 2013, 417 titanium cranioplasties for small suboccipital craniectomy were performed in our institution. Four hundred and nine cases were treated with titanium cranioplasty after MVD primarily and eight cases were treated for repeated procedure after MVD. In this report, we present two cases of exposed titanium mesh. Both patients suffered from complications after repeated procedures. Case Reports I. Case 1A 62-year-old underweight female (height 157 cm, weight 45 kg, and BMI 18.3 kg/m 2 ), who had undergone MVD for left facial spasm and repair of cerebrospinal fluid leakage 5 years before at our hospital, visited again because she felt a strange projection under the left postauricular skin. The titanium mesh implanted at the second surgery was exposed from the operative scar (Fig. 1A). Computed tomography (CT) revealed exposure of the titanium mesh with no evidence of intracranial pathology (Fig. 1B, C), which indicated the need for removal of the titanium mesh. After obtaining informed consent, primary skin closure was completed after removal of the titanium mesh and debridement of the affected skin. No gross evidence of infection was observed. She was treated with intravenous cefazolin sodium hydrate (CEZ) 2 g/day for 5 days and discharged from our hospital with no evidence of further complication. II. Case 2A 75-year-old underweight female (height 150 cm, weight 38.6 kg, and BMI 17.2 kg/m 2 ), who had undergone MVD for right trigeminal neuralgia 10 years and 5 years before, visited our hospital again because she noticed mucus on the operative scar. The shape of titanium mesh that had been implanted at the second surgery was visible at the operative scar ( Fig. 2A). CT showed that the titanium mesh was exposed with partial absence of the skin. There was no evidence of subcutaneous or intracranial pathology (Fig. 2B, C). Removal of the titanium mesh was indicated and after obtaining informed consent, primary skin closure was completed using the same procedure as in the previous case. No definitive infection was observed around the affected wound Two cases of exposed titanium mesh occurred after implantation for cranioplasty after repeated procedures for microvascular decompression (MVD). Case 1 was a 62-year-old female who underwent MVD for left hemifacial spasm followed by repair of cerebrospinal fluid leak after the surgery, and Case 2 was a 75-year-old female who underwent MVD twice for right trigeminal neuralgia. Both patients visited our hospital again with complaints of postauricular lesion. Titanium mesh was visible through the operative scar and was successfully removed with no complication in both cases. Both patients were underweight females, and combined with multistep surgery may have contributed to the pathology. The present cases suggest that use of titanium mesh should be av...

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Comparison of Polyetheretherketone and Titanium Cranioplasty after Decompressive Craniectomy

Cited by 155 publications

References 21 publications

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

Clinical application of triangular parabolic PEEK mesh with hole button produced by combining CAD, FEM and 3DP into cranioplasty

Exposure of Titanium Mesh after Cranioplasty for Microvascular Decompression Surgery: Two Case Reports

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