Page 109 - Clinical relevance of current materials for cranial implants

Data collection
Data collection included the following patient parameters: gender, age at time of PEEK
cranioplasty, medical comorbidities (diabetes, cardiovascular disease, obesity (body
mass index > 30), preoperative radiotherapy, smoking, indication for craniectomy
(trauma, stroke, tumor, infection) and side of surgery (unilateral, bilateral, frontal).
Surgical reports were carefully analysed with regard to the timing of cranioplasty. A
difference was made between immediate and delayed cranioplasty. Cranioplasty was
defined as ’immediate’ when there was no interval between craniectomy or removal
of previous cranioplasty with autologous bone or PMMA. Delayed PEEK cranioplasty
was performed after after an interval of wound healing, leaving the brain temporarily
unprotected. The time between previous surgery (craniectomy or cranioplasty)
and PEEK cranioplasty was listed, as well as the number of surgeries prior to PEEK 5 cranioplasty and the complication-rate after previous cranioplasty using autologous
bone or PMMA. Other surgery-related data that were collected included preoperative shaving of the surgery site, incorporation of the previous scar into the skin incision or use of additional incisions, suspension of the temporal muscle, intraoperative placement of a subgaleal drain and operation time and the size of the defect. Defect size was measured with the use of 3D software (Maxilim software (Medicim NV, Mechelen, Belgium) and Autodesk 3ds Max 2012 (Autodesk Inc. USA)), which takes into account the curvature of the skull (Figure 1).
The main outcome parameters were defined as the presence of any complication after PEEK cranioplasty (infection, hematoma, cerebrospinal fluid (CSF) leak, wound-related problems) and the need for any medical (use of antibiotics) or surgical intervention (drainage of a hematoma, surgical repair of a CSF leak, use of a reconstructive skin flap, removal of the implant) after cranioplasty.
Follow-up reports of the neurological status of patients were studied. Patients who had a normal neurological status before and after PEEK cranioplasty were excluded. Patients or their relatives were contacted by phone to obtain a subjective evaluation of the evolution of the neurological status after PEEK cranioplasty. A simple rating scale was scored as follows: 1: significant neurological deterioration; 2: moderate deterioration; 3: no change; 4: moderate improvement; 5: significant improvement.
PEEK cranioplasty
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