gms | German Medical Science

Objective: For several decades, cranial defects following decompressive craniotomy have been reconstructed in different ways. Whenever autologous bone is not an option, allogenic materials have to be used. Together with the development of computer-aided-design, patient-specific implants (PSI) manufactured on the basis of CD-scans have come to the market, which were made of titanium. Recently, PSI made of PEEK (polyetheretherketone) were made available. We describe the first case of PEEK-PSI in Germany and highlight the advantages and possible disadvantages of the material from the neurosurgeon's point of view.

Methods: After data-acquisition using spiral CT, data were sent to the manufacturer (Synthes, Umkirch/Germany) for planning of the PSI. Images were electronically sent to the treating neurosurgeon for approval, and modifications were applied where necessary. The PSI was implanted in general anaesthesia and affixed to the skull using titanium miniplates after intra-operative modification using high-speed-drills. Postoperative CT-scan was performed to rule out complications and demonstrate adequate fit of the PSI.

Results: The main advantages of the material are: 1.) translucency for x-rays 2.) minimal artefacts on MRI-scans 3.) option for intraoperative modification of the PSI to ensure optimal fit using standard tools at hand. Possible disadvantages include the need for longer preoperative preparations, the relatively higher costs and the loss of a potential antimicrobial effect compared to titanium.

Conclusions: Our experience with PEEK-PSI demonstrate that PEEK is a suitable material for PSI. It seems superior to titanium especially when postoperative imaging studies are intended. High costs limit the application as is the case with other PSI. Long-term results, especially concerning infection rates, remain to be observed.