Letter: Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression

In Reply: Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression

“…As such, it is entirely unclear as to what "evidence" the authors refer to, given that no evidential primary literature is referenced. We agree with Tinterri et al 1 in that these materials are likely different and should ideally be reported separately, but there is no robust evidence of this difference to date, to the best of our knowledge. Given the issues with applying this criterion and the lack of evidence for the distinction, we did not consider it reasonable to apply.…”

“…We agree with Tinterri et al 1 in that material choice should be individualized and multifactorial to include patient preferences and clinical status, surgical preferences, and anatomical considerations. That said, these choices should also take empirical evidence for standardized outcomes into account where there is equipoise.…”

“…We thank you for the opportunity to respond to the comments by Tinterri et al 1 In their comments, they present several perceived flaws in our study, 1,2 which we respond to here. Our use of a 2-mo cutoff for mean follow-up was determined in the planning phase by assessment of the current literature.…”

“…6 Patients with evidence of multimetal hypersensitivity have higher rates of titanium cranioplasty failure, 15 and some authors have observed what appears to be this inflammatory process, with scalp thinning over titanium implants topographically unrelated to the wound in most cases. 3 It is unclear by what index Tinterri et al 1 consider it the “most bioinert,” given that alloplastic materials are also generally considered bioinert. 16,17…”

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

“…Third, our study is not sufficient to conclude the relationship between the properties of PEEK and the higher incidence of epidural effusion. Insights into the biomechanics of PEEK, surface design patterns, and communication between subgaleal and extradural/subdural spaces may further facilitate the choice of cranioplasty material ( 46 ). Finally, the timing of cranioplasty has a certain impact on patients' outcomes ( 47 ), but this issue is not discussed in the present study, as this is a small cohort.…”