Our experience with PEEK cranioplasty implant on patient with massive defect

Accepted as an ePoster in The European Association of Neurosurgical Societies Congress 2019.

INTRODUCTION

A young lady had a large portion of skull removed during cranioectomy to release elevated intracranial pressure caused by a car accident. She was admitted to our department, looking forward to an aesthetic restoration.

Typical cranioplasty materials used in Colombia include autologous bone, bone cement, and Ti mesh. However, given the size, autologous bone repair is not possible, and it is hard for shaping such a large piece of bone cement during the surgery. At this size, the sharp edge of Ti mesh could potentially cut the scalp and lead to infection at a large scale, and it would be challenging to achieve a perfectly fitted Ti mesh for this patient.

In recent years, the use of PEEK in cranioplasty has received more and more attention. It is an ideal repair material for this case with its good mechanical properties and completely customized manufacturing method.

OBJECTIVES

• To achieve aesthetic restoration with the PEEK implant

METHOD

• CT and MRI images of the images of the patient were obtained and reconstructed
• The implant was digitally designed

- Design engineer communicated with surgeon to ensure aesthetic fit

- Three interlaying pieces for cost-saving purpose

• The implant was manufactured, sterilized on-site and used

RESULTS

• The final implant contained three interlaying pieces

- L:90.7*82.1mm, M:97.9*68.1mm, R:87.5*83.5mm

- Individually fixed to surrounding bone tissue

- Easy to place one piece after another

- As a whole provided perfect fit to the defect

• No extra modification of the implant or the surround bone tissue needed

- Customized design based on patient's image data to ensure perfect fit

• Contour was restored immediately

- Patient was very satisfied with the outcome

• No post-surgical complications

- No short or long term complaints

DISCUSSION AND CONCLUSION

• PEEK could be an ideal material for cranioplasty

- Biocompatible and non-toxic

- Similar modulus to bone, no stress shielding

- High mechanical strength yet light-weighted

- No image artifacts

- Inlay design, not protruding skin

• Customized design to ensure perfect fit to the defect

- Key is to have quantified CT and MRI images

- Effective communication with surgeon is required

- Implant features can also be customized

?? Thickness, size and location of drainage holes, etc

- Especially suitable for cases with high aesthetic need

?? Massive defect, frontal or orbital defects

?? Maxillofacial repair and plastic surgery

• Further reduction in cost is necessary

- PEEK raw material is costly

- One piece to multiple pieces

- 3D printing of implant

FUTURE DIRECTIONS

• Further improvement of implant design and degree of customization

- Fixation method, location of screws, etc

- Save as much surgical time as possible

• More effective engineer-surgeon communication
• Use PEEK implant in more cranioplasty cases
• Explore the use of PEEK implant in maxillofacial repair and plastic surgeries

REFERENCE

1. W. M. A. Abd El-Ghani, “Cranioplasty with polymethyl methacrylate implant: solutions of pitfalls,”Egypt. J. Neurosurg., vol. 33, no. 1, p. 7, 2018.

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please contact Medprin

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