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Computer-Designed Polyetheretherketone Implants Versus Titanium MeshAcrylic Cement) in Alloplastic Cranioplasty: A Retrospective Single-Surgeon, Single-Center Study

Ng, Zhi Yang MBChB*; Ang, Wei Jie Jensen BMedSci(Hons); Nawaz, Irfan MBBS, FRCS

Journal of Craniofacial Surgery: March 2014 - Volume 25 - Issue 2 - p e185–e189
doi: 10.1097/SCS.0000000000000623
Brief Clinical Studies

Background Polyetheretherketone (PEEK) has emerged as one of the most promising alloplastic materials for calvarial reconstruction because of a number of desirable qualities including resistance to heat and ionizing radiation, biocompatibility, biomechanically similar to native bone, and being nonferromagnetic for postoperative monitoring. We aimed to evaluate and compare the outcomes of alloplastic cranioplasty performed with PEEK, titanium mesh only (Ti-only), and titanium mesh with acrylic cement (Ti-AC); titanium mesh has previously recorded many successes with low complication rates.

Methods A retrospective, single-surgeon, single-center study for alloplastic cranioplasties was performed between January 2008 and December 2012. Titanium meshes were fashioned intraoperatively, whereas PEEK implants were prefabricated from high-resolution computed tomography scans. Patients were routinely followed up in outpatient settings.

Results Twenty-four patients (75% male) underwent delayed cranioplasty following initial craniectomy. Four Ti-only and 3 Ti-AC patients had postoperative complications including wound breakdown and implant exposure. These assumed a bimodal distribution with time postoperatively and culminated in implant removal in 6 patients, of which 4 required further plastic flap coverage. Subgroup analysis showed no significant differences in predictive factors apart from cranioplasty material with means as follows: age = 42 years, interval to surgery = 10 months, defect size = 12 × 9 cm, operation duration = 181 minutes, hospital stay = 13 days, follow-up = 11 months.

Conclusions Early results suggest that PEEK may be superior to Ti-only or Ti-AC as an alloplastic cranioplasty choice. Further research should include randomized trials between computer-aided, prefabricated titanium and PEEK cranioplasties with larger sample sizes and longer follow-up.

From the *Department of Plastic Reconstructive and Aesthetic Surgery, KK Women’s and Children’s Hospital, Singapore; †College of Medicine and Veterinary Medicine, University of Edinburgh, Scotland, United Kingdom; and ‡Division of Neurosurgery, Changi General Hospital, Singapore.

Received September 23, 2013.

Accepted for publication December 2, 2013.

Address correspondence and reprint requests to Zhi Yang Ng, MBChB, Department of Plastic Reconstructive and Aesthetic Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd, Singapore 229899; E-mail:

The authors report no conflicts of interest.

© 2014 by Mutaz B. Habal, MD.