• Qiuming Zhang, Yikai Yuan, Xuepei Li, Tong Sun, Yicheng Zhou, Hang Yu, and Junwen Guan.
• Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
• World Neurosurg. 2018 Apr 1; 112: e645-e651.

ObjectiveCranioplasty (CP) can be either embedded or covered, according to the implants used. However, determining which one is better in treating cranial defects is difficult. This study aimed to compare the clinical outcomes and complications of embedded CP and covered CP.MethodsA multicenter retrospective study was undertaken with patients who underwent CP with polyetheretherketone (PEEK) implants and titanium implants between January 2014 and March 2017. The medical records of these patients were reviewed retrospectively and analyzed statistically.ResultsThere were 185 patients, including 75 patients (40.5%) who underwent embedded CP with PEEK implants (PEEK group) and 110 patients (59.5%) who underwent covered CP using titanium mesh (titanium group), in this study. Compared with the titanium group, the incidence of overall complications (P = 0.03), postoperative new seizures (P = 0.01), postoperative implant exposure (P = 0.03), and reoperation (P = 0.01) was significantly lower in PEEK group. The rate of brain function improvement (P = 0.01) after CP and satisfaction with CP (P = 0.01) in patients in the PEEK group were higher than that in the titanium group.ConclusionsOur results show that embedded CP with PEEK has a distinct advantage in brain function improvement and fewer postoperative complications compared with covered CP with titanium mesh. However, the high cost of PEEK is an obvious drawback. This study can help both neurosurgeons and patients in choosing a better therapeutic method to achieve the most satisfactory outcome in treating cranial defects.Copyright © 2018 Elsevier Inc. All rights reserved.

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