J. D. Oliver2, J. B. Mancilla1, K. Vyas1, B. Sharaf1 1Mayo Clinic,Plastic And Reconstructive Surgery,Rochester, MN, USA 2Mayo Clinic,School Of Medicine,Rochester, MN, USA
Introduction: There are currently numerous options for reconstructive surgeons to repair acquired defects of the cranium. Traditionally, autologous bone tissue was used as the gold-standard in cranial vault reconstruction, dating back to the early 1600’s. More recently, alloplastic cranioplasty was developed and has evolved significantly over the years as numerous alterations have been implemented, including the development of different materials to serve as a medium of repair to the defect, such as Titanium Mesh (Ti), Polymethyl Methacrylate (PMMA), Polyether Ether Ketone (PEEK), and Norion implants. There is little data in the literature today comparing the surgical outcomes of these various types of alloplastic cranioplasty methods, and there has yet to be published a systematic review of such outcomes among the alloplastic materials we have compared in this study. Our objective in this study is to compare postoperative rates of infection, local complications and allograft failures following cranioplasty reconstruction using Titanium Mesh (Ti), Polymethyl Methacrylate (PMMA), Polyether Ether Ketone (PEEK), and Norion implants.
Methods: We performed the first systematic review of available literature on four different methods of alloplastic cranioplasty reconstruction, including Titanium Mesh (Ti), Polymethyl Methacrylate (PMMA), Polyether Ether Ketone (PEEK), and Norion implants, using the Newcastle-Ottawa Quality Assessment Scale guidelines for article identification, screening, eligibility and inclusion. The electronic literature search included Medline/Pubmed, Scopus and Cochrane Database.
Results: A total of 47 studies and 2,972 adult patients were included in our review. Overall, Titanium Mesh (Ti) was associated with the lowest post-operative infection rate (3.71%) and fewest post-operative local complications (9.23%), as well as the lowest number of graft failures requiring reoperation (1.80%) as compared to Polymethyl Methacrylate (PMMA), Polyether Ether Ketone (PEEK), and Norion implants, all of which yielding significantly higher rates of infection, local complication, and ultimate graft failure postoperatively. The rates of infection, local complications, and graft failure in PMMA, PEEK, and Norion were found to be: 7.10%, 8.75%, and 19.56%, respectively for infection; 11.40%, 20.0%, and 26.09% for local complications; and 3.37%, 7.50%, and 15.22% for graft failure.
Conclusion: Current data suggests greater outcomes as measured by infection rate, local surgical complication rate, and graft failure rate in Titanium Mesh (Ti) cranioplasty reconstruction. This study qualifies as a preliminary analysis that begins to address the knowledge gap in determining the infection, local surgical complication and failure rates in alloplastic cranioplasty procedures, although longer-term and randomized trials are warranted to validate any association found in this study.