Outcomes of Cranioplasty with Preformed Titanium versus Freehand Molded Polymethylmethacrylate Implants

Cranioplasty reshapes the neurocranium and viscerocranium after craniectomy. Different materials have been used for cranioplasty. However, no consistent data are yet available comparing these different materials regarding indications, complications, and outcome. We report our experience with preformed titanium implants and freehand molded polymethylmethacrylate (PMMA) implants for cranioplasty.

This retrospective single-center analysis included 120 consecutive cranioplasty patients who had been operated between 2006 and 2013. A total of 60 patients (27 women, 33 men; mean age: 54 years) had received a preformed titanium implant and 60 patients (22 women, 38 men; mean age: 46 years) a freehand molded PMMA implant. We evaluated all demographic and procedure-related data, indications, and outcome. The longest follow-up was 5.5 years.

The most frequent indications for cranioplasty were trauma (n = 48 [40%]), malignant infarction (n = 27 [23%]), tumor (n = 22 [18%]), spontaneous intracerebral or aneurysmal subarachnoid hemorrhage (n = 16 [13%]), revision surgery (n = 5 [4%]), and empyema (n = 2 [2%]). PMMA implants were more often associated with wound-healing disorders (p < 0.023; odds ratio [OR]: 10.53) and epidural hematoma (p < 0.03; OR: 8.46), resulting in a significantly higher re-operation rate (p < 0.005). Precise fitting was radiologically confirmed in 98% of titanium implants but in only 71% of PMMA implants (p < 0.001). Magnetic resonance imaging of patients with titanium implants (n = 4) did not show any relevant artifacts.

Cranioplasty with preformed titanium implants seems to be superior to freehand molded PMMA implants regarding surgical morbidity, revision rate, and aesthetic results.