A Retrospective Study on Subgaleal Fluid Collection After Titanium Mesh and Polyetheretherketone Cranioplasty

Jian Guo; Xu Hou; Junying Zeng; Xiaodong Chen; Shizhong Zheng; Bingchu Xu; Shoulian Zheng; Zhiliang Liu; Gengqiang Ling

doi:10.1016/j.wneu.2024.11.121

A Retrospective Study on Subgaleal Fluid Collection After Titanium Mesh and Polyetheretherketone Cranioplasty

World Neurosurg. 2024 Dec 26:194:123538. doi: 10.1016/j.wneu.2024.11.121. Online ahead of print.

Authors

Jian Guo¹, Xu Hou¹, Junying Zeng², Xiaodong Chen², Shizhong Zheng¹, Bingchu Xu¹, Shoulian Zheng¹, Zhiliang Liu¹, Gengqiang Ling³

Affiliations

¹ Department of Neurosurgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
² Department of Internal medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
³ Department of Neurosurgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China. Electronic address: linggengqiang@sysush.com.

PMID: 39643208
DOI: 10.1016/j.wneu.2024.11.121

Abstract

Objective: Cranioplasty is a common neurosurgical procedure aimed at providing structural protection to cerebral tissues and enhancing neurological function. The choice of implant material, particularly polyetheretherketone (PEEK) and titanium mesh, significantly influences postoperative outcomes, including the incidence of subgaleal fluid collections (SFC). This study investigates the incidence of SFC associated with PEEK and titanium mesh in cranioplasty, identifying risk factors and implications for clinical practice.

Methods: A retrospective analysis was conducted on 70 patients who underwent cranioplasty. The incidence of SFC, postoperative complications, and demographic data were collected and analyzed. Statistical comparisons were made between the 2 implant materials.

Results: The incidence of SFC was significantly higher in the PEEK group (46.2%) compared to the titanium mesh group (20.5%) (P = 0.023). PEEK was identified as an independent risk factor for SFC. Additionally, approximately 60% of postoperative epidural hematoma cases presented with SFC, highlighting the importance of meticulous hemostasis during surgery. The overall reoperation rate was 5.7%, consistent with existing literature. Although diabetes mellitus did not show a statistically significant association with SFC (P = 0.064), its potential impact on postoperative complications warrants further investigation.

Conclusions: The selection of implant materials in cranioplasty significantly affects postoperative outcomes, with PEEK associated with a higher incidence of SFC. Careful material selection, particularly in patients with comorbidities, and meticulous surgical techniques are essential to improve patient outcomes. Future research should focus on the biological interactions between implant materials and cranial tissues to refine guidelines for clinical practice.

Keywords: Complication; Cranioplasty; Decompressive craniectomy (DC); Polyetheretherketone (PEEK); Subgaleal fluid collections (SFC); Titanium mesh.