New Concept in Cranioplasty Based on Biomaterials Performance in Various Clinical Cases

Abstract

Today, there are four known types of grafts for cranioplasty: autogenic grafts (the same bone is reused such) such as bone from cranium, ribs, shinbones, shoulder blades, sternum or ilia, allogenic grafts (the graft originates from another human) such as cartilage, xenogenic grafts (grafts transplanted from animals ex: bovines, pigs, etc.) and alloplastic gra fts (graft consisting of inorganic material) such as celluloid, Polymethylmethacrylate-PMMA, polyetheretherketone-PEEK, hydroxyapatite, polyethylene, silicone, ceramic and other derivatives; metallic implants such as Aluminium, Gold, Silver, Lead, Platinum, Titanium, Tantalum and their alloys. In this paper, the authors perform a comprehensive review of how the techniques have evolved from classic metals to modern biopolymers and how the modern technology will impact the future of cranial reconstruction. Also, comparative aspects related to the use of modern biopolymers like PMMA and PEEK in cranioplasty will be revealed based on surgical experience and clinical cases. Modern technology enables neurosurgeons to understand the threedimensional anatomy of the skull and defect and allows them to be able to create implants perfectly tailored to the size and shape of the defect without neglecting the volumetry of the skull. The best materials of today appear to be PEEK due to their excellent mechanical properties other properties like non-immunogenicity, non-oncogenicity, sterility, biological tolerance and an acceptable price range.