Evaluating the Role of Material Choice in Cranioplasty Revisions: Impact on Infection Outcomes and Revision Success Rates

Introduction: Postoperative infections are a frequent and challenging complication of cranioplasty procedures, often necessitating revision surgeries and prolonged patient recovery. Despite the prevalence of these complications, the influence of initial cranioplasty material on the revision course remains unclear. Additionally, there is little guidance for selecting an optimal material for revision following infection. This study aims to investigate the association between cranioplasty materials and the outcomes of revision procedures.

Methods: A retrospective review was conducted on 50 patients at our institution who required a revision cranioplasty following infection.Data collected included the procedure type (craniotomy or craniectomy), material used in initial and revision cranioplasties (autologous bone, PEEK or other bioplastics, and titanium), the largest defect diameter, time from the initial procedure to infection, and revision failure rates. Statistical analyses, including chi-squared tests and Fisher’s exact tests were conducted to test associations among these variables.

Results: Among the 50 patients, initial cranioplasty materials included autologous bone (n=21), titanium (n=16), and PEEK or other bioplastics (n=5). Revision cranioplasties consisted of titanium (n=9), PEEK or other bioplastics (n=28), and autologous bone grafts (n=2), with the remaining patients having implants of unknown material. There were no significant associations between the initial cranioplasty material and time to infection (P=.217). Furthermore, the selection of initial cranioplasty material did not significantly predict the material used in revision, X2 (1,N=50) = 2.3, P=.679. PEEK or other bioplastics used in revision cranioplasty were associated with an average axial defect diameter of 0.75 cm larger than the cohort average (P=0.494) and a high failure rate, with 64.7% of patients requiring explantation (P <.001).

Conclusion : While the material used in the initial cranioplasty did not significantly affect revision outcomes, the choice of revision material may impact the likelihood of explantation and further intervention. Future studies should explore optimal material selection for revision cranioplasty to improve patient outcomes and minimize revision failure.