title: Computer-designed polyetheretherketone implants versus titanium mesh (± acrylic cement) in alloplastic cranioplasty: a retrospective single-surgeon, single-center study.
abstract: 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.
authors.affiliation: 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.
authors.forename: Zhi Yang
authors.initials: ZY
authors.lastname: Ng
authors.forename: Wei Jie Jensen
authors.initials: WJ
authors.lastname: Ang
authors.forename: Irfan
authors.initials: I
authors.lastname: Nawaz
mesh_terms: D000328:Adult; D000368:Aged; D001577:Benzophenones; D017076:Computer-Aided Design; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007659:Ketones; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D011108:Polymers; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D014025:Titanium; D014057:Tomography, X-Ray Computed
chemical_list: D001577:Benzophenones; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols; D019904:Polymethyl Methacrylate; D014025:Titanium