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  • Outcome analysis of preformed titanium versus free-hand polymethylmethacrylate cranioplasty

    Final Number:

    Karl-Michael Schebesch MD; Julius Sebastian Hoehne; Alexander T. Brawanski MD, PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Cranioplasty restores cranial function and reshapes the neuro- and viscerocranium after craniectomy. Several materials have been used for cranioplasty, but no consistent data have yet been presented that compare indications, complications, and outcome regarding the material used. We report our experiences with preformed titanium (CRANIOTOP®, CL Instruments, Attendorn, Germany) and free-hand polymethylmethacrylate (PMMA) cranioplasty in a large study population.

    Methods: In this mono-centric retrospective analysis, we included 122 consecutive patients between 2006 and 2013. 61 patients (28 women, 33 men; mean age 54 years) received a preformed titanium implant and 61 patients (21 women, 40 men; mean age 46 years) a free-hand PMMA cranioplasty. We evaluated all demographic and procedure-related data, indications, and outcome parameters and screened the postoperative images for any relevant hemorrhage, fitting accuracy, and artifacts. The mean follow-up was 2 months.

    Results: The most frequent indications were infarction (N=31, titanium n=12, PMMA n=19), acute subdural hematoma (N=24, titanium n=14, PMMA n=10), and skull-base meningioma (N=16, titanium n=8, PMMA n=8). Patients in the PMMA group required significantly longer operating times (p=0.02), had more cerebral fluid leaks (p=0.003), and a significantly higher revision rate (p=0.04) than patients in the titanium group. Postoperative imaging confirmed accurate fitting for all patients in the titanium group but only for 69% of patients in the PMMA group (p<0.001). Postoperative magnetic resonance imaging (MRI) of patients with titanium implants (n=5) did not show any relevant artifacts.

    Conclusions: For cranioplasty, preformed titanium seems to be superior to PMMA with regard to surgical morbidity, revision rates, and esthetic results. Because titanium does not show as artifact in MRI, correct postoperative evaluation is warranted, which may justify the significantly higher costs of titanium cranioplasty.

    Patient Care: Improvement of cosemtic results, functional outcome and complications after cranioplasty

    Learning Objectives: Cranioplasty and cosmetic restoration of the skull in the context of modern materials and techniques


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