Cranioplasty Using Autologous Bone versus Porous Polyethylene versus Custom-Made Titanium Mesh : A Retrospective Review of 108 Patients

Abstract

Objective: The purpose of this study was to compare the cosmetic outcome and complications after cranioplasty (CP) due to three different implant materials, and analyze the mean implant survival and cumulative survival rate based on these results.

Methods: We reviewed 108 patients retrospectively who underwent CP between January 2014 and November 2016. Autologous bone (AB; 45 patients) and synthetic materials with porous polyethylene (PP; 32 patients) and custom-made 3-dimensional printed titanium mesh (CT; 31 patients) were used as implants.

Results: Regardless of implanted materials, more than 89.8% of the CP patients were satisfied with the cosmetic outcome. No statistically significant difference was observed among the three groups. The overall postoperative complication rates of each group were 31.1% in the AB group, 15.6% in the PP group and 3.2% in the CT group. The CT group showed lower complication rates compared with AB and PP groups (χ2-test : AB vs. PP, p=0.34; AB vs. CT, p=0.00; PP vs. CT, p=0.03). The AB and PP groups demonstrated a higher post-CP infection rate (11.1% and 6.3%) than the CT group (3.2%). However, no significant difference in the incidence of post-CP infection was observed among the three groups. The PP and CT groups demonstrated a higher mean implant survival time and cumulative survival rate than the AB group at the last follow-up (p<0.05).

Conclusion: In comparison with AB and PP, cranioplasty with CT shows benefits in terms of lower post-CP complication, less intraoperative bleeding loss, shorter operation time and in-hospital stay. The PP and CT groups showed higher implant survival time and cumulative survival rate compared with the AB group.

Keywords: Bone resorption; Infection; Reconstructive surgical procedure; Titanium.

Fig. 1.

The Medpor (porous polyethylene) implant (A). Post-operative lateral skull radiograph showing radiolucent Medpor implant (b).

Fig. 2.

The 3D design for printing custom-made titanium implant (A). Titanium mesh was placed on the defect site with screw fixation (b).

Fig. 3.

Computed tomographic image of bone flap resorption demonstrating complete lysis of both inner and outer tables in the bilateral skull.

Fig. 4.

Kaplan-Meier plots of the cumulative implant survival rate demonstrated significantly longer implant survival in patients undergoing CP with PP and CT compared with those treated with Ab conservatively (p< 0.05). CP : cranioplasty, PP : porous polyethylene, CT : custom-made 3-dimensional printed titanium mesh, Ab : autologous bone.