Cranial Bone Flap Fixation: Comparison of Titanium-Based Device (Skull Fix) and PEEK-Based Device (Cranial Loop): Technical Report

Abstract
Background: Reconstruction of the cranial bone flap after craniocerebral surgery is crucial for preservation of skull symmetry, maintenance of aesthetics, brain protection, as well avoiding complications like floating or sunken skull flaps. A host of techniques and materials for fixation of the cranial flaps have emerged over the past several decades.
Aim of Study: The aim of this study was to compare the clinical outcomes of bone flap fixation using peek-based (cranial loop) versus titanium-based (skull fix) fixation systems.
Patients and Methods: Between July 2013 and December 2016 a series of 54 patients undergoing either an emergency or an elective craniotomy for different intracranial lesions in which the original bone flaps were refixed using cranial loop in 27 patients and skull fix in 27 patients. Clinical and radio-logical outcomes and complication rates were compared between these 2 groups.
Results: Satisfactory results were achieved in both fixation systems. Epidural collection occurred in 4 patients 3 in skull fix and one in cranial loop, subdural collection in 4 patients 2 in cranial loop and one in skull fix treated conservatively. One case with cranial loop experienced a bone flap dislocation which was revised and refixed. Subcutaneous effusion occurred in two patients one in skull fix and one in cranial loop. One patient in skull fix developed a mild postoperative wound infection. Post-operative imaging showed satisfactory ana-tomical and morphological position of the flap in all patients.
Conclusion: Skull fix and cranial loop are reasonable alternatives to present craniotomy fixation methods. They are easy to use, fast, safe, reliable with very acceptable cosmetic results. The main advantage of the cranial loop might ultimately lie in the absence of artifacts on post-operative CT or MR imaging.