Page 113 - Clinical relevance of current materials for cranial implants

ABG = autologous bone graft *: Final loss of PEEK cranioplasty
Figure 2. Schematic overview regarding cranioplasty timing
The complications after PEEK cranioplasty are given with the initial indication of craniectomy between brackets. Solid border: immediate PEEK cranioplasty; 2 complications were seen in 15 cranioplasties.
Dashed border: delayed cranioplasty; 9 complications were seen in 25 cranioplasties.
Overall complications
Twenty-nine PEEK implants (73%) were without any complication. 11 complications were seen in 11 patients. Complications (28%) consisted of infection (n = 5), hematoma (n = 4), CSF leak (n = 1) and wound-related problems (n = 1). Ten cranioplasties (25%) required additional surgery. Three (epidural) hematomas were surgically evacuated, one CSF leak needed surgical repair and one patient had a skin flap necrosis, which was reconstructed with a latissimus dorsi flap. Five PEEK implants (12.5%) were removed due to infection. In three of these patients the same PSI was re-used after sterilization after 1.8, 3.8 and 8.0 months, without further complications. Two patients refused re-operation and consequently a permanent loss of PEEK cranioplasty was seen in 5%. There was no mortality observed within six months after PEEK cranioplasty. The overall infection rate after cranioplasty was 13%. Staphylococcus aureus was the predominant pathogenic microorganism in four of these five cases. One patient with a postoperative (subgaleal) hematoma received conservative treatment, without the need for additional surgical intervention. Postoperative subcutaneous seroma formation was observed in four cases and resolved spontaneously in all. The median time between PEEK cranioplasty and the presentation of complications was 35 days (n = 11, IQR 4.5-90.5).
PEEK cranioplasty
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