Evaluation of three different methods of cranioplasty; a comparative prospective randomized study

Document Type : Original Articles


1 Department of Neurosurgery, Faculty of Medicine, Helwan University, Egypt.

2 Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt.

3 Faculty of Medicine, Tanta University, Egypt


Background: Multiple materials have been used for cranioplasty with different pros and cons. However, the current literature is poor with studies comparing titanium mesh, polyetheretherketone (PEEK) and bone cement (PMMA). This prospective randomized study was conducted to compare the outcomes of the previous three techniques used for cranioplasty.
Purpose: Comparison between three common methods for cranioplasty regarding multiple points including results, complications and patients satisfaction.
Patients and methods: A total of 84 cases were included, and they were randomly divided into three groups (28 cases in each); titanium, PEEK and PMMA groups. All patients underwent proper pre-operative preparation including history taking, neurological examination and routine investigations. The operative time and post-operative complications were recorded. Our primary outcome was implant failure rates, whereas secondary outcomes included post-operative new onset seizures, exposure, extradural hemorrhage, surgical site infection, graft resorption, and patient satisfaction.
Results: Age, sex, indication for cranioplasty, and operative time did not show any significant differences between the three groups. The prevalence of implant failure was 10.7%, 3.6%, and 14.3% in the same groups respectively. Although all complications tended to have a higher prevalence in the PMMA group (apart from extradural hemorrhage), no significant difference was detected between the three groups regarding these complications. This led to a significant decrease in patient satisfaction in the PMMA group.
Conclusion: Titanium, PEEK, and PMMA have a comparable complication profile when used for cranioplasty. However, complication rates showed slight increase in PMMA, which led to decreased patient satisfaction in that group.