Revision Cranioplasty with Three-dimensional Custom-made Titanium Implants in Patients with Failed Cranioplasty

Graft failure is a common complication of cranioplasty. Revision cranioplasty is required to overcome this complication. However, no previous studies have reported outcomes in revision cranioplasty with 3-dimensional (3D) custom-made titanium implants. We describe our experience with 3D titanium implants in patients with revision cranioplasty.

We evaluated 43 consecutive patients between January 2011 and December 2019 who underwent revision cranioplasty using 3D custom-made titanium implants. The 3D image of the patient's cranium and the plan to close the cranium defect were created in a virtual environment using software programs. Demographic and radiologic features were compared based on the materials used in the initial cranioplasty.

Previous material was autologous graft (AG) in 27 patients and polymethyl methacrylate (PMMA) in 16 patients. The mean time without revision cranioplasty is longer in patients with PMMA implants than in patients with AG. There was no statistically significant difference in the length of hospital stay between patients with PMMA implants and patients with AG. There were no postoperative adverse events such as infection, wound dehiscence, convulsions, or epidural hematoma in 38 patients during hospitalization. Wound dehiscence developed in 5 patients and surgical repair was required in one.

Initial cranioplasty with PMMA provides a longer time period than the AG before the revision. However, both of them have similar outcomes based on length of hospital stay and cranial defect area. Custom-made 3D titanium implant is a good option for revision cranioplasty to prevent implant failure and reduce patients' cosmetic concerns.