Introduction: Polyetheretherketone (PEEK) has, in recent years, emerged as one of the most promising alloplastic material for calvarial reconstruction due to a number of qualities including resistance to heat and ionizing radiation, biocompatibility and inertness, biomechanically similar to native bone, and non-magnetic for post-operative monitoring [1]. Our study aimed to evaluate and compare the outcomes of alloplastic cranioplasty performed with PEEK and titanium mesh, which has previously recorded many successes with low complication rates [2].

Methods: A retrospective, single-surgeon, single-center study for alloplastic cranioplasties (titanium with hydroxyapatite cement, titanium mesh only, and PEEK) performed between February 2009 and September 2012. Titanium meshes were fashioned intra-operatively while the PEEK implants were prefabricated from high resolution computed tomography (CT) scans. All patients are on on-going follow-up in the outpatient setting.

Results: 16 patients (63% males; mean age = 44, range 16 – 67) underwent delayed cranioplasty after a mean time interval of 11 months (range 3 – 40) following initial decompressive craniectomy. All cranial defects were located over the temporo-parietal region and the average size was 11 x 9 cm (range 9 x 7 – 12 x 10 cm). The scalp was closed primarily in all cases and the average surgery time was 179 minutes (range 110 – 275). The mean length of hospital stay was 9 days (range 4 – 41). Sub-group analysis showed no significant difference in patient age, defect size, operative time, and hospitalization period between the three cranioplasty groups. 5 patients with titanium mesh cranioplasties had wound breakdowns (Figure 1) at an average of 9 months post-operative (range, 1 – 21); 4 required implant removal and 3 required plastics flap coverage.

Conclusions: Early results suggest that PEEK may be a superior alloplastic cranioplasty material compared to titanium mesh +/- hydroxyapatite cement. Longer-term follow-up and greater patient numbers are required for statistical significance.

Patient Care: This is the first comparative study in the literature between consecutive PEEK and titanium mesh cranioplasties by a single surgeon at the same institution. The results shown suggest that PEEK may provide a superior outcome to titanium meshes, which have been previously used with much success.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) recognize the properties of PEEK implants 2) appreciate the different materials used in alloplastic cranioplasty (namely PEEK and titanium) 3) suggest why PEEK may be superior to titanium for cranioplasty

References: 1. Hanasono MM, Goel N, DeMonte F. Calvarial reconstruction with polyetheretherketone implants. Ann Plast Surg. 2009; 62(6): 653-655. 2. Janecka IP. New reconstructive technologies in skull base surgery: role of titanium mesh and porous polyethylene. Arch Otolaryngol Head Neck Surg. 2000; 126(3):396-401.