Comparison Between Titanium and Polyether Ether Ketone Cranioplasty Based on Preoperative Imaging Indicators and...

Managing postoperative adverse events after cranioplasty (CP) remains a significant clinical challenge. Consensus is lacking on optimizing the choice between titanium (Ti) and polyether ether ketone (PEEK).

To identify independent risk factors for postoperative adverse events and establish evidence-based criteria for individualized material selection using preoperative imaging.

We retrospectively reviewed 211 CP patients (110 Ti, 101 PEEK) treated between 2018 and 2024. Multivariate regression identified risk factors for overall adverse events. Generalized additive models and piecewise regression were employed to analyze the nonlinear interaction between the calculated preoperative "abnormal volume ratio" and material type, aiming to identify clinical decision thresholds.

Age (odds ratio=1.03, P = 0.010) and brain collapse volume (odds ratio=1.03, P = 0.042) were independent risk factors for postoperative adverse events. Generalized additive model revealed a significant interaction between material type and abnormal volume ratio (P = 0.019). Piecewise regression identified a key threshold: when the abnormal volume ratio exceeded 3.5%, the number of adverse events was significantly lower in the Ti group than in the PEEK group (P < 0.05).

Age and brain collapse volume are independent predictors of adverse events after CP. More importantly, this study reveals that the preoperative "abnormal volume ratio" acts as a critical effect modifier. For patients with an abnormal volume ratio greater than 3.5%, our findings suggest that selecting Ti might be associated with a lower adverse event burden. This provides a preliminary, data-driven framework for individualized material selection, a hypothesis that requires validation in prospective clinical trials.