gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Polymethyl-methacrylate cranioplasty as an excellent alternative to autograft bone flap

Meeting Abstract

  • M. Merkle - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • A. Dimostheni - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • G. Maier - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • M. Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • F. Roser - Klinik für Neurochirurgie, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 035

doi: 10.3205/11dgnc256, urn:nbn:de:0183-11dgnc2569

Published: April 28, 2011

© 2011 Merkle et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Bone flap reimplantation after decompressive craniectomy always carries the risk of secondary infection or resorption of the implanted bone. As an alternative, polymethyl-methacrylate (PMMA) implants can be used. However, as they are foreign bodies, lower infection rates must be proven. Therefore, we conducted a retrospective study on patients after decompressive craniectomy with replacement of the skull defect either with autograft or allograft prostheses, in which we investigated outcome concerning infection rates and hardware failure.

Methods: Retrospectively collected data on 48 consecutive patients with decompressive craniectomy over a 20-month period were analyzed. After a minimum of three months after decompressive craniectomy, patients underwent a second surgery to cover their skull defect. 24 patients received replacement of the original bone flap stored in a –80°C freezer, whereas in 24 patients, covering of the skull defect was performed by computer-designed PMMA prostheses. The postoperative complications of both groups were reviewed and compared. Postoperative cranial computed tomography was performed and evaluated concerning the anatomical reconstruction.

Results: All patients had a minimum follow-up of 6 months. The group with the autograft bone reimplantation showed two postoperative epidural hemorrhages and in two other cases infection of the skull bone was diagnosed. The allograft group using PMMA prostheses showed no surgical site infection or postoperative sub-/epidural or subgaleal bleeding. Regarding the cosmetic results, the computed tomography of patients with PMMA prostheses showed a better anatomical reconstruction than the group with autograft bone.

Conclusions: The polymethy methacrylate (PMMA) prostheses are an excellent option for cranioplasty when autogenous bone graft is not existent or suitable. Especially the anatomical reconstruction seems to be profitable and with computational modeling, specifics such as an atrophic temporal muscle can be reconstructed. Furthermore the infection rates with PMMA prostheses are lower compared to the use of autogenous bone graft.