Cranioplasty Complications and Outcomes When Using PEEK Or Autologous Bone: A Single-Center Experience

Introduction: Decompressive craniectomy is performed for malignant ischemic stroke and traumatic injury. Usage of polyether-ether-ketone (PEEK) or autologous bone flaps for subsequent cranioplasty is largely determined by provider preference. Currently, there is no consensus on whether cranioplasty material impacts complication rates or clinical outcomes. Here we compared the rate of complications and 1-year follow-up GOS-E between cranioplasty material types.

Methods: Patients undergoing cranioplasty following either ischemic stroke or traumatic injury at a single site were analyzed between December 2013 and June 2023. Two-sample Student’s t-tests and Fisher’s exact tests were performed to compare continuous and categorical variables. Significance level was 0.05.

Results: Of 69 patients, 22 (32%) had ischemic strokes, and 47 (68%) had traumatic injury. Forty-nine (71%) cranioplasty patients received autologous bone, and 20 (29%) patients received PEEK. The most common reason (11/20, 55%) patients received PEEK flaps was because bone at the initial injury was unsalvageable. Patients with cranioplasties performed greater than 90 days after craniectomy had significantly more (p=0.012) PEEK flaps than autologous flaps (AF). Median EBL was 200mL with no significant difference (p=0.311) between PEEK and AF. Median Glasgow Outcome Scale Extended (GOS-E) was 5 (IQR 4-7) with no significant difference (p =0.916) between PEEK and AF. LOS was not significantly different (p=0.806) between PEEK and AF. CSF flow diversion (i.e. EVD, LD, Serial LP, VP Shunt) was performed in 17/69 (25%) of patients. CSF diversion did not differ significantly (p=0.229) between PEEK and AF. Post-craniectomy complications (Hematoma, Infection, Meningitis, Hydrocephalus) were not significantly different (p=0.296) between patients with PEEK and AF. Surgical case length was not significantly different (p=0.084) between PEEK and AF.

Conclusion : Autologous and PEEK cranioplasties had similar operative and clinical outcomes. This suggests PEEK flaps are a non-inferior alternative, particularly in patients with unsalvageable AF. Further multivariate analyses can aid in clarifying optimal cranioplasty material.