Evaluation of titanium cranioplasty and polyetheretherketone cranioplasty after decompressive craniectomy for traumatic brain injury

Abstract

Introduction: Cranioplasty following decompressive craniectomy is routinely performed to restore integrity of skull and improve neurological function. However, reconstructing the cranial defect brings many challenges to neurosurgeons and search for ideal implant materials is one of the most controversial issues. Although many studies have compared the outcomes of titanium and polyetheretherketone (PEEK) cranioplasty, yet no prospective study exists to guide the choice of titanium and PEEK materials. Methods/design: A non-randomized, partially blinded, prospective cohort study is described that comprehensively compares the long-term outcomes of titanium cranioplasty versus PEEK cranioplasty. One hundred forty-five patients for each group will be recruited. Eligible patients are those with cranial defect due to traumatic brain injury (≥ 16 years), defect size is over 25 cm 2 and they must agree to participate in the trial. Each participant is evaluated before surgery, on discharge, 3, 6, and 12 months after cranioplasty. The primary outcome is the infection, implant failure and implant deformation requiring revision surgery within 12 months. Secondary outcomes include postoperative complication rate, neurological outcomes, motor function, and cosmetic outcome over a 6-month period. Discussion: Search for ideal implant materials is throughout the history of cranioplasty. This study will provide robust evidence for the choice of cranioplasty materials. Trial registration number: ChiCTR2000033406

Histological Processing of CAD/CAM Titanium Scaffold after Long-Term Failure in Cranioplasty

“…Osteointegration and sufficient soft tissue coverage seems to be a major issue for long-term success, especially regarding the reason for late plate infection, as seen in this case. For comparing titanium cranioplasty versus PEEK cranioplasty, Yang et al proposed a prospective, multicenter, non-randomized controlled trial in 2020 to evaluate the long-term outcome (trial registration number: ChiCTR2000033406) [ 32 ].…”

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

“…The primary outcome of the current study was the rate of implant failure, which was defined as infection, exposure, or any other complication that requires implant removal. 11 Implant exposure was defined as extrusion or exposure of the implant secondary to skin erosion. 21 Secondary outcomes included implant exposure, surgical site infection, graft resorption, postoperative new-onset seizures, extradural hemorrhage, and patient satisfaction.…”

“…9,10 Therefore, bone grafts have been replaced by other materials to decrease resorption rate and donor site morbidity. 11 Bone cement or polymethyl methacrylate (PMMA) (Teknimed, Biomaterials Innovation, Gentafix 1 ®, France) has proven to be useful in cranioplasty. It was used to fill the spaces between the two bones, acting as a grout.…”

“…12 It is malleable, lightweight, strong, and heat resistant, however, it may cause burn injury during the process of its preparation. 11,13 Bone cement has been used alone in cranioplasty, especially for managing relatively small calvarial defects. 14 Titanium mesh (TiMesh ®, Medtronic, Minneapolis, Minnesota, USA) has been widely used in cranioplasty surgeries.…”

“…20 Currently, a great controversy exists between different neurosurgeons regarding the choice of implant material. 11 Although the existing literature is rich in papers comparing only two of the previously mentioned techniques, there is a paucity of studies comparing these three implants (Titanium mesh, PEEK, and bone cement). Hence, we conducted the current study to compare the outcomes of these three techniques used for cranioplasty.…”