A Novel Flexible Polyetheretherketone Barrier Reduces Dural Adhesion and Facilitates Galea-Dura Dissection After...

Decompressive craniectomy can cause dense dural adhesions that complicate later cranioplasty. We evaluated whether a thin, flexible 3-dimensional printed polyetheretherketone (PEEK) sheet could serve as an antiadhesion barrier to reduce scarring and facilitate reoperation in an experimental neurosurgery model.

Bilateral 10-mm parietal craniectomies were performed in adult New Zealand White rabbits (n = 7). A sterilized 0.5-mm PEEK film (3-dimensional printed) was placed over one dural defect; the contralateral defect was untreated. After 12 weeks, re-exploration simulated delayed cranioplasty. Investigators, blinded to treatment side, graded operative feasibility by ease of galea-dura dissection and bleeding. Harvested tissues were hematoxylin and eosin stained for morphology, and image morphometry quantified fibrosis area fraction.

PEEK-implanted sites exhibited clear, nonadherent planes: Scalp and galea separated easily from dura with gentle dissection and minimal bleeding, and the PEEK film detached cleanly with no dural injury. Control sides had dense fibrovascular adhesions requiring forceful dissection and resulting in epidural bleeding. Histologically, PEEK-treated defects showed a thin organized fibrous layer and preserved dura, whereas controls had abundant granulation tissue and inflammatory infiltrates extending into meninges and brain. Quantitatively, fibrosis area fraction was significantly lower at PEEK sites (<5%) than controls (∼30%-40%; P < .05).

This experimental neurosurgery model provides preclinical evidence that a thin, flexible 3-dimensional printed PEEK barrier significantly reduces dural adhesions and epidural fibrosis, facilitating atraumatic reoperation. The novel PEEK film was surgically feasible and shows translational potential to improve safety and efficiency of delayed cranioplasty by minimizing adhesion-related complications.