Clinical outcomes and material-selection considerations for titanium mesh and patient-specific polyetheretherketone cranioplasty: a retrospective cohort study

Objective To compare outcomes after titanium mesh and patient-specific polyetheretherketone (PEEK) cranioplasty and to interpret the findings in the context of material-specific clinical indications. Methods We retrospectively analyzed 99 patients who underwent cranioplasty over four years with either titanium mesh (n = 60, 60.6%) or patient-specific PEEK implants (n = 39, 39.4%). Available demographic, operative, neurological, cognitive, postoperative inflammatory, temperature, and complication data were compared. Preoperative inflammatory markers, estimated blood loss, transfusion, and standardized patient-satisfaction outcomes were not consistently available. Results The groups differed in age and comorbidity burden (both p < 0.01) but not in sex, defect-diameter category, or operative duration. NIHSS, GOS, and MMSE scores did not change significantly within the titanium group. Within the PEEK group, NIHSS and GOS did not change significantly, whereas MMSE increased at 3 months ( p = 0.005). The complication-free proportion was 41.7% in the titanium group and 64.1% in the PEEK group (unadjusted p = 0.029). Mean temperature during the first three postoperative days was 37.17 ± 0.36 °C in the titanium group and 36.91 ± 0.31 °C in the PEEK group ( p < 0.01). These comparisons were unadjusted and do not establish causality. Conclusion In this retrospective cohort, PEEK was associated with fewer recorded postoperative complications and lower mean postoperative temperature, while MMSE improved within the PEEK group. These unadjusted findings do not establish universal material superiority. Implant selection should be individualized according to defect size and geometry, anatomical location, soft-tissue condition, prior infection or implant failure, cosmetic requirements, availability, and cost.