Comparison of Polyetheretherketone and Titanium Cranioplasty after Decompressive Craniectomy

OBJECTIVE: To characterize complication and failure rates and outcomes of patients who underwent cranioplasty with polyetheretherketone (PEEK) and titanium implants and to compare complication and failure rates between the 2 implants. METHODS: A retrospective cohort study of patients who underwent cranioplasty with PEEK patient-specific implant (PEEK Optima-LT) and preformed titanium mesh at the National Neuroscience Institute, Singapore, between January 2001 and February 2012 was performed. Data related to initial decompressive craniectomy and cranioplasty, associated complications after cranioplasty, and indication for revision or removal of implants were collected. Cranioplasty failure was defined as revision or removal of a patient's implant. RESULTS: Overall complication rates for PEEK and titanium cranioplasty were 25.0% and 27.8%, respectively. The combined complication rate was 27.3%. A trend toward increase in exposed implant in titanium cranioplasty compared with PEEK cranioplasty was observed (P = 0.074). There were 3 of 24 (12.5%) cranioplasty failures with PEEK, and 27 of 108 (25%) cranioplasty failures with titanium (P = 0.129). Previous deep infection in patients after decompressive craniectomy was associated with cranioplasty complications (odds ratio, 23.3; confidence interval, 3.00-180.5; P = 0.003) and failure (odds ratio, 22.5; confidence interval, 2.82-179.0; P = 0.003). CONCLUSIONS: The findings from this study highlight that cranioplasty is associated with significant complications, including the necessity for reoperation. It is hoped that the information in this study will provide better understanding of the risks associated with PEEK and titanium cranioplasty and contribute to decision making by the clinician and patient.