Autologous Bone, Titanium Mesh, and Polyetheretherketone in Cranioplasty: Early Reconstruction-Related Complications in 105 Patients

Background: Complications after cranioplasty are common, and the reconstruction material is one of the few modifiable factors. Comparisons of these materials have focused mainly on long-term failure, driven by resorption of the autologous bone flap. We compared autologous bone, titanium mesh, and polyetheretherketone (PEEK) with respect to early reconstruction-related complications.Methods: We retrospectively reviewed 105 consecutive patients who underwent cranioplasty after decompressive craniectomy at a single center from 2021 to 2026 (autologous bone 63, titanium mesh 29, PEEK 13). The primary outcome was a composite of extra-axial collection, subgaleal fluid collection, and implant failure within 90 days. The three materials were compared by multivariable logistic regression adjusting for age and by time-to-event analysis; autologous bone versus synthetic materials combined was a secondary analysis.Results: The composite complication occurred in 30 patients (28.6%): 28.6% with autologous bone, 17.2% with titanium mesh, and 53.8% with PEEK (p=0.052). Relative to autologous bone, the adjusted odds ratio was 0.56 (95% confidence interval 0.18–1.74) for titanium mesh and 3.48 (0.86–14.08) for PEEK; relative to titanium mesh, the odds ratio for PEEK was 6.24 (1.37–28.41). Subgaleal fluid collection was more frequent with PEEK (46.2%) than with titanium mesh (10.3%) or autologous bone (14.3%; p=0.021). All events were identified within 51 days (median 4 days). Defect area was not associated with outcome.Conclusions: No significant difference was detected among the three materials, although the study was not powered for this comparison. The higher rate of subgaleal fluid collection with PEEK should be examined in larger cohorts.