title: Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty.
abstract: OBJECTIVE
  Traditional cranioplasty methods focus on pre-operative or intraoperative hand molding. Recently, CT-guided polyether ether ketone (PEEK) plate reconstruction enables precise, time-saving reconstruction. This case series aims to show a single institution experience with use of PEEK cranioplasty as an effective, safe, precise, reusable, and time-saving cranioplasty technique in large, complex cranial defects.
  
  
  METHODS
  We performed a 6-year retrospective review of cranioplasty procedures performed at our affiliated hospitals using PEEK implants. A total of nineteen patients underwent twenty-two cranioplasty procedures. Pre-operative, intra-operative, and post-operative data was collected.
  
  
  RESULTS
  Nineteen patients underwent twenty-two procedures. Time interval from injury to loss of primary cranioplasty averaged 57.7 months (0-336 mo); 4.0 months (n=10, range 0-19) in cases of trauma. Time interval from primary cranioplasty loss to PEEK cranioplasty was 11.8 months for infection (n=11, range 6-25 mo), 12.2 months for trauma (n=5, range 2-27 mo), and 0.3 months for cosmetic or functional reconstructions (n=3, range 0-1). Similar surgical techniques were used in all patients. Drains were placed in 11/22 procedures. Varying techniques were used in skin closure, including adjacent tissue transfer (4/22) and free tissue transfer (1/22). The PEEK plate required modification in four procedures. Three patients had reoperation following PEEK plate reconstruction.
  
  
  CONCLUSIONS
  Cranioplasty utilizing CT-guided PEEK plate allows easy inset, anatomic accuracy, mirror image aesthetics, simplification of complex 3D defects, and potential time savings. Additionally, it's easily manipulated in the operating room, and can be easily re-utilized in cases of intraoperative course changes or infection.
authors.affiliation: Dept. of Plastic Surgery, Naval Medical Center San Diego, San Diego, CA, USA.
authors.forename: Eamon B
authors.initials: EB
authors.lastname: O'Reilly
authors.affiliation: Dept. of Neurological Surgery, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Barnett
authors.affiliation: Dept. of Neurological Surgery, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Madden
authors.affiliation: Dept. of Neurological Surgery, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Babu
authors.initials: B
authors.lastname: Welch
authors.affiliation: Dept. of Neurological Surgery, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Mickey
authors.affiliation: Dept. of Plastic Surgery, University of Texas Southwestern, Dallas, TX, USA. Electronic address: shai.rozen@utsouthwestern.edu.
authors.forename: Shai
authors.initials: S
authors.lastname: Rozen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001577:Benzophenones; D001672:Biocompatible Materials / Q000627:therapeutic use*; D017076:Computer-Aided Design; D005260:Female; D006801:Humans; D007659:Ketones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011108:Polymers; D019736:Prostheses and Implants; D011474:Prosthesis Design; D015641:Radiography, Interventional; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D001577:Benzophenones; D001672:Biocompatible Materials; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols
keywords: Cranioplasty; PEEK; Polyether ether ketone; Revision cranioplasty