Meta-analyses of the surgical outcomes using personalized 3D-printed titanium and PEEK vs. standard implants in cranial reconstruction in patients undergoing craniectomy.

Abstract

The introduction of 3D-printing technology in cranial reconstruction introduces novel opportunities to optimize surgical outcomes. This meta-analysis investigates the efficacy of 3D-printed titanium and polyetheretherketone (PEEK) implants versus standard non-3D-printed implants in cranial reconstructions following craniectomy. A systematic search across PubMed, Cochrane, Embase, and Scopus was conducted, identifying studies between 2003 and 2024 meeting the inclusion criteria. 9 studies and a total of 942 patients were included in our analysis, of which 318 received 3D-printed implants and 624 underwent standard cranioplasties. Our results showed that 3D-printed titanium implants significantly reduced total complication rates (OR: 0.26, p = 0.0009) compared to standard implants, whilst 3D-printed PEEK implants presented with no statistical difference in comparison to standard implants (OR: 1.02, p = 0.972). Similarly, 3D-printed implants showed a significant decrease in infection rates compared to standard implants (OR: 0.33, p = 0.0238). However, 3D-printed implants were also associated with increased risk of effusion (OR: 2.20, p = 0.0103). There were no other significant differences in complications such as epilepsy, hematoma, or dehiscence. Although these findings suggest the potential benefits of 3D-printed implants in cranioplasty, specifically those of titanium implants, the quality of the current literature on the topic is relatively poor with the majority of studies being single-center retrospective studies. Therefore, prospective randomized control studies are required to confirm these trends and elucidate the comparative efficacy of this technique to standard treatment. Keywords: Cranioplasty; Cranial Reconstruction; 3D Printing; Personalized; Titanium; PEEK.