gms | German Medical Science

Objective: Cranioplasty restores cranial function and reshapes the neurocranium and viscerocranium after craniectomy. Various materials have been used for cranioplasty, and virtually designed computerized implants have found increasingly wider use. However, no consistent data are yet available that compare the different materials regarding indications, complications, and outcome. We report our experiences with preformed titanium (CRANIOTOP^®, CL Instruments, Attendorn, Germany) and free-hand polymethylmethacrylate (PMMA; PALACOS, Haereus, Germany) cranioplasty in a large study population.

Method: In this retrospective mono-centric analysis, we included 122 consecutive patients who had been operated on in our neurosurgical department between 2006 and 2013. 61 patients (28 women, 33 men; mean age 54 years) had received a preformed titanium implant and 61 patients (21 women, 40 men; mean age 46 years) free- hand PMMA cranioplasty. We evaluated all demographic and procedure-related data, indications, and outcome parameters and screened the postoperative images for any relevant hemorrhage, accurate fitting, and artifacts.

Results: Overall the most frequent indications for cranioplasty were post-malignant infarction (titanium n=12, PMMA n=19), acute subdural hematoma (n=14 vs. n=10) and skull base meningiomas (n=8 vs. n=8). Age and gender were evenly distributed across the groups. Mean operation time was significantly longer in the PMMA group (mean 148 vs. 128 min. p=0,02). The revision rate was significantly higher in the PMMA group (p=0,04) following more frequent CSF leakage (p=0,003). Fitting of the implant and cosmesis, as confirmed by CT scan and observer judgment, was overall better in the titanium group (p=<0,001). Postoperative MRI with the titanium implant (n=5) was free of any relevant artifacts.

Conclusions: For cranioplasty, preformed titanium seems to be superior to PMMA with regard to surgical morbidity, revision rates, and esthetic results. Because titanium does not present as a relevant artifact in MRI, correct postoperative evaluation is warranted and may justify the significantly higher costs of this type of cranioplasty.