Background: Cranioplasty is a common neurologic procedure, with complication rates ranging from 20% to 50%. It is hypothesized that the risks of various complications are affected by which material is used for cranioplasty.
Objective: To evaluate the literature comparing rates of complications after cranioplasty using different materials including autologous bone, hydroxyapatite, methyl methacrylate, demineralized bone matrix, polyetheretherketone, titanium, or composite materials.
Methods: The PubMed/MEDLINE database was searched for relevant articles published between 2010 and 2020. After screening, 35 articles were included. Outcomes included infection, wound problems, poor cosmesis, overall complications, duration of surgery, and length of stay. For each outcome, a frequentist network meta-analysis was conducted to compare materials used.
Results: The risk of infection was 1.62 times higher when methyl methacrylate was used compared with autologous bone (relative risk, 1.62; 95% confidence interval [CI], 1.07-2.45). Length of stay after cranioplasty was on average 3.62 days shorter when titanium was used compared with autologous bone (95% CI, 6.26 to -0.98). The networks constructed for other outcomes showed moderate to substantial between-study heterogeneity, wide CIs, and no significant differences between materials.
Conclusions: The quality of existing literature on this topic is relatively poor, almost exclusively comprising single-center retrospective studies. There is not strong enough evidence available to make comprehensive conclusions regarding the risk profiles of various cranioplasty materials across multiple outcomes. Prospective randomized trials are necessary to confirm the significant results found in this analysis and to further elucidate the differential risks of various cranioplasty materials.
Keywords: Craniofacial reconstruction; Cranioplasty; Implantable materials; Materials.
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