The Materials Utilized in Cranial Reconstruction: Past, Current, and Future

Abstract

Background: Cranioplasty (CP) is associated with high complication rates compared to other common neurosurgical procedures. Several graft materials are used for CP, which may contribute to the high complication rates, but data in the literature regarding the influence of graft material on post-CP outcomes are inconsistent making it difficult to determine if, when, and to what extent the graft material impacts the rate of perioperative complications. There is an increased demand to identify and develop superior graft materials. Objective: To review and compare the indications, risks, complications, and patient results associated with the use of different graft materials for cranial reconstructions. Design: A search through EBSCO host was conducted using the keywords “craniectomy” or “decompressive craniectomy,” “cranioplasty,” and “materials.” The search was limited to literature published in the English language from 2005 until the present. Ultimately, 69 articles were included in this review. Due to the heterogeneity of the study populations, results, statistical analyses, and collecting methods, no statistical analyses could be performed. Conclusions: Several graft materials have been adapted for use in cranial reconstructions with inconsistent results making it unclear if or when one material may be indicated over others. Advances in computer-aided design have led to improved patient-specific implants, but the ideal graft material is still being sought after in ongoing research efforts. Reviewing materials currently available, as well as those in clinical trials, is important to identify the limitations associated with different implants and to guide future research.

Polyether Ether Ketone (PEEK) Implants and the Manufacturer and User Facility Device Experience (MAUDE) Database: An Updated Review of Adverse Events and Complications

“…The implant was subsequently removed, yet the patient’s hospital course was complicated by postoperative seizures; this has similarly been cited in the literature 5 . Moreover, the literature suggests a slightly higher complication and infection rate associated with PEEK compared with autologous materials 6–9 . In a review of 280 patients who underwent cranioplasty with autologous bone, Schuss and colleagues, reported a complication rate of 16.4%, whereas Chang and colleagues, reported that allografts had higher rates of infection than autologous bone grafts 5,10,11 .…”

Patient-specific implants for craniomaxillofacial surgery: A manufacturer's experience

“…Such materials quickly become commercially unviable and therefore unlikely to remain in clinical practice over extended periods of time. Moreover, no single craniomaxillofacial implant material has emerged with the ideal biomimetic properties [ [24] , [25] , [26] ], and, as such, the choice of implant material should be tailored to optimise each clinical case based on an assessment of the material properties ( Table 1 ).…”

Designing cranial fixture shapes and topologies for optimizing PEEK implant thickness in cranioplasty

“…Typically, cranioplasty is performed after a craniotomy, and the development of the defect and its correction is separated by time. 1 It focuses on using surgical procedures to treat skull injuries and defects. Craniotomy is a surgical treatment that involves removing a portion of the skull to relieve pressure on the brain caused by swelling or bleeding.…”