Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty
Section snippets
Background
Cranial decompression is one of the earliest recorded surgical procedures reported thousands of years ago as trephination with the Peruvian pre-Incans, North Africans, and independently discovered by Hippocrates and Galen.1, 2 More recently, Kocher and Cushing popularized decompressive craniectomy; indications include stroke, intracranial hemorrhage, and trauma.2, 3, 4, 5 With the upswing of craniectomies came a modernization of a secondary necessary intervention: cranioplasty.
Cranioplasty has
Materials and methods
We performed a retrospective review of 19 patients receiving CT based PEEK cranioplasty over a six-year period at a university teaching hospital and level I trauma hospital (Parkland Memorial Hospital). Inclusion criteria included patients who had: 1) prior decompressive craniectomy; 2) failed primary bone auto-graft or other non-autologous cranioplasty; and 3) subsequently underwent PEEK cranioplasty. We excluded all patients with other forms of cranioplasty.
Institutional review board approval
Results
The 19 patients who met inclusion criteria underwent a total of 22 PEEK cranioplasty procedures from January 1st, 2006 until October 9th, 2012. The average age at the primary craniectomy procedure was 39.6 (range 15–81); and 12/19 patients were male. Initial mechanism of injury was traumatic in 10/19 patients, neoplastic in 6/19, vascular in 2/19, and stroke in one patient.
The average time from initial insult to loss of the primary cranioplasty, bone graft or other material, was 57.7 months (n
Discussion
Any surgery with multiple solutions presents a possible proof to a time-honored surgical dictum: if there are many ways to solve a problem, then perhaps there is no best way. The optimal cranioplasty should be performed reliably, expediently, with minimal complications, resulting in a superb esthetic outcome, and full vascularization of the graft or implant – this technique does not currently exist.
Approaches to cranioplasty may be divided into two general techniques: autologous and implants.
Conclusion
Cranioplasty utilizing CT-guided PEEK plate reconstruction has several advantages—ease of inset with excellent anatomic accuracy; unrivaled mirror image esthetic results; simplification of complex three dimensional defects; potential intra-operative time saving, especially during difficult exposures. The plate is also easily modified in the operating room when necessary, and may be reused if the initial cranioplasty fails due to infection or other reasons. Keys to success include meticulous
Funding
None declared.
Conflicts of interest
None declared.
Ethical approval
Not required.
Disclosure
“The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.”
“This work was prepared as part of my official duties. Title 17, USC, §105 provides that ‘Copyright protection under this title is not available for any work of the U.S. Government.’ Title 17, USC, §101 defines a U.S. Government work as a work prepared by a military service member or
Acknowledgments
We would like to thank Lisa Belser, our talented photographer at UTSW, for the photographs in this article.
References (34)
- et al.
Custom made bioceramic implants in complex and large cranial reconstruction: a two-year follow-up
J Craniomaxillofac Surg
(2012) - et al.
Traumatic fracture of a polymethyl methacrylate patient-specific cranioplasty implant
World Neurosurg
(2014 Sep–Oct) - et al.
In vitro biocompatibility testing of polymers for orthopaedic implants using cultured fibroblasts and osteoblasts
Biomaterials
(1995) - et al.
Customised fabricated implants after previous failed cranioplasty
J Plast Reconstr Aesthet Surg
(2010) - et al.
Cranioplasty with custom-made implants: analyzing the cases of 10 patients
J Oral Maxillofac Surg
(2012) - et al.
One-step primary reconstruction for complex craniofacial resection with PEEK custom-made implants
J Craniomaxillofac Surg
(2014 Mar) - et al.
Computer-assisted designed and computer-assisted manufactured polyetheretherketone prosthesis for complex fronto-orbito-temporal defect
J Oral Maxillofac Surg
(2011) - et al.
A treatment algorithm for patients with large skull bone defects and first results
J Craniomaxillofac Surg
(2011) - et al.
Parietal skull reconstruction using immediate PEEK cranioplasty following resection for craniofacial fibrous dysplasia
J Plast Reconstr Aesthet Surg
(2014) - et al.
Use of two-piece polyetheretherketone (PEEK) implants in orbitozygomatic reconstruction
Br J Oral Maxillofac Surg
(2012)
Autologous and acrylic cranioplasty: a review of 10 years and 258 cases
World Neurosurg
Repairing holes in the head: a history of cranioplasty
Neurosurgery
The current status of decompressive craniectomy
Br J Neurosurg
Warfare-related craniectomy defect reconstruction: early success using custom alloplast implants
Plast Reconstr Surg
Cranioplasty complications following wartime decompressive craniectomy
Neurosurg Focus
Management of decompressive craniectomy defects: modern military treatment strategies
J Craniofac Surg
Materials and techniques for osseous skull reconstruction
Minim Invasive Ther Allied Technol
Cited by (55)
Integrated porous polyetheretherketone implants for treating skull defect
2023, Journal of Materials Research and TechnologyEvaluating patients’ satisfaction level after using 3D printed PEEK facial implants in repairing maxillofacial deformities
2022, Annals of Medicine and SurgeryCitation Excerpt :Researchers took a retrospective study of 37 patients who had suffered trauma and then received reconstructive surgery using PEEK-based cranial compensation, which was “patient specific” printed for each patient at the Toulouse University Hospital, France, with an average follow-up period of 4.3 years from 2 moths to 9 years, but no mention was made of the type of printer used in their study [23]. In 2015 O'Reilly et al. [24] conducted a 6-year retrospective study of cranioplasty surgeries of 19 patients who underwent 22 cranioplasty surgeries using PEEK implants planned and based on CT scans. The cranial injury was caused by a trauma in 10 patients, from a tumor in 6 patients, from a vascular injury in 2 patients, and from a stroke in a single patient - The PEEK plate implant needed modification in four cases -.
Patient-Specific Three-Dimensional Printing Guide for Single-Stage Skull Bone Tumor Surgery: Novel Software Workflow with Manufacturing of Prefabricated Jigs for Bone Resection and Reconstruction
2021, World NeurosurgeryCitation Excerpt :Owing to good biocompatibility, light weight, low radiopacity, strong resistance to functional stress, easy handling, and low cost, PMMA became the most frequently used material and is still regarded as the alloplastic material of choice, with lower rates of reported complications than with autologous bone.34-36 Commercially available prefabricated patient-specific implants, such as those made of hydroxyapatite, polyetheretherketone, and titanium, provide improved cosmetic outcome and reduced operative time but are expensive.6,37-39 The price of prefabricated titanium, polyetheretherketone, or hydroxyapatite implants is greater than US $7500.6,37,40
The application of polyetheretherketone (PEEK) implants in cranioplasty
2019, Brain Research BulletinCranioplasty with patient-specific implants in repeatedly reconstructed cases
2019, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :In accordance with the patient, no further reconstructive attempt will be made, since several infections had occurred before the PEEK PSI placement. In PEEK implant case series, complication rates between 0% and 35% have been reported, next to surgical removal rates ranging from 0% to 18.2% (Ng and Nawaz, 2014; Alonso-Rodriguez et al., 2015; Gerbino et al., 2015; O'Reilly et al., 2015). No complications were seen in patients receiving a titanium cranioplasty; however, it should be noted that only a limited number of patients were treated with titanium PSIs.