10 March 2026 : Meta-Analysis
Complications of Alloplastic Graft Materials Used in Cranioplasty: Systematic Review and Network Meta-Analysis
Abdulaziz Fahad Samandar
ACDEF 1*, Muna F. Alnaim ADEF 2, Sarah Qari BDE 3, Jawahir AlTamimi BDEF 4, Kausar Ahmed BDEF 5, Faris Alharbi ABCDEF 6, Abdulrahman M. Alhazmi BE 7, Eyad Sindi AEF 4, Houriah Yasir Nukaly ABEF 8, Raghad Abdullah Selate BF 6, Hatem Abdulmoamen Alnoman AEF 9
DOI: 10.12659/MSM.950551
Med Sci Monit 2026; 32:e950551
Table 1 Characteristics of included studies.
| Author/year/country | Study design | Patient demographics | Material used | Follow-Up (months) | Complication | Indications for cranioplasty | Risk of bias | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Sample size | Mean age | Sex | Intervention | Comparators | Intervention | Comparator | NOS | ||||
| Iaccarino et al, 2015, Italy []35 | Prospective cohort | 96 | 50.1 ±14.5 | Male | PEEK (n=48) | PMMA (n=16), HA (n=32) | 11 | Infection (n=2) (PEEK) | Implant exposure (n=5) (PMMA), infection (n=2) HA | Cerebrovascular, cranial diseases, TBI | High risk |
| Alonso-Rodriguez et al, 2015, Spain []33 | Retrospective cohort | 14 | 42.8 | 4 Male; 10 Female | PEEK (n=7) | PMMA (n=7) | 28.6 | No complication | Implant exposure (n=2) | Traumatic brain injury, tumor, hematencephalon | Low risk |
| Thien, 2015, Singapore []49 | Prospective cohort | 132 | 39.25 | 85 Male; 47 Female | PEEK (n=57) | Ti (n=75) | 16.8 | Implant exposure (n=2), hemorrhage (n=1), infection (n=3) | Implant exposure (n=9), seizures (n=12), infection (n=10), hemorrhage (n= 1) | Traumatic brain injury, tumor, hematencephalon, stroke, congenital birth defect | Moderate risk |
| Ng et al, 2015, Singapore []37 | Retrospective cohort | 24 | 40.33 | 12 Male; 12 Female | PEEK (n=7) | Ti (n=9), Ti-Ac (n=6) | 28 | Hemorrhage (n=1) | Stroke (n=2), implant exposure (n=2), seizures (n=5) | Hematencephalon, other cranial diseases | Moderate risk |
| Lee et al, 2015, Korea []36 | Retrospective cohort | 140 | 53.1 | 85 Male; 55 Female | PEEK (n=70) | PP (=70) | 18.2–82.6 | Infection (n=8); hemorrhage (n=5) | Stroke (n=3), implant exposure (n=1), infection (n=2) | Traumatic brain injury, tumor | Moderate risk |
| Piitulainen et al, 2015, Finland []38 | Retrospective cohort | 108 | 42.1 | 94 Male; 14 Female | PEEK (n=40) | Ti (n=20), fiber-reinforced composite (n=9), HA (n=15), PMMA (n=9), polyethylene (n=15) | 21.6 | No complication | Implant exposure (n=5), seizures (n=2), hemorrhage (n=10), Infection (n=12) | Traumatic brain injury, stroke, hematencephalon, congenital birth defect | Low risk |
| Foster et al, 2016, USA []46 | Prospective cohort | 672 | 52.5 | 336 Male; 336 Female | HA (n=117) | Ti (n=185) | 32.8 | Infection (n=14) | Implant exposure (n=10), seizures (n=9) | Traumatic brain injury, tumor, hematencephalon, stroke, congenital birth defect | Low risk |
| Lindner et al, 2017, Germany []44 | Retrospectie | 52 | 53.2 | 38 Male; 14 Female | HA (n=10) | Ti (n=42) | 28 | Infection (n=2) | Infection (n=5) | Traumatic brain injury | Moderate risk |
| Zegers et al, 2017, Netherland []42 | Retrospective cohort | 29 | 43.3 | 29 Male | PEEK (n=19) | Ti (n=10) | 28 | Infection (n=1) | No complication | Traumatic brain injury | Low risk |
| Zhang Q et al, 2018, China []43 | Retrospective cohort | 185 | 35.42 | 97 Male; 88 Female | PEEK (n=79) | Ti (n=56) | 13.85 ±4.9 | Infection (n=7), seizures (n=6), hematoma (n=1) | Infection (n=10), implant exposure (n=12), cerebrospinal fluid (n=4), seizures (n=5) | Traumatic brain injury, infection, other cranial defects | Moderate risk |
| Yeap et al, 2019, Taiwan []50 | Retrospective cohort | 227 | 42.3 | 184 Male; 43 Female | PMMA (n=84) | Ti (n=98) | 39 | Infection (n=20), healing-related issues (n=10) | Infection (n=6), healing-related issues (n=10) | Traumatic brain injury, tumor, hematencephalon, stroke, congenital birth defect | Low risk |
| Rashidi et al, 2019, Germany []18 | Retrospective cohort | 329 | 45.3 | N/A | PEEK (n=61) | PMMA (n=42) | 13.2 | Infection (n=5), hematoma (n=10) | Infection (n=12), cerebrospinal fluid (n=5) | Cerebrovascular, traumatic brain injury | Low risk |
| Rosinski et al, 2020, USA []45 | Retrospective cohort | 82 | 57.4 | 74 Male; 8 Female | PEEK (n=57) | Ti (n=25) | 47 | Infection (n=5) | No complications | Traumatic brain injury | High risk |
| Ganau et al 2020, France []4 | Retrospective cohort | 218 | 41.3 | 142 Male; 72 Female | PHA (n=12) | PMMA (n=47) | 32 | Infection (n=4), asymptomatic fractures (n=2), hydrocephalus (n=2), intra cranial hemorrhage (n=2) | Infection (n=16), hydrocephalus (n=8), intracranial hemorrhage (n=3) | Traumatic brain injury, tumor, ischemia | Moderate risk |
| Koller et al 2020, USA []47 | Retrospective cohort | 60 | 39.7 | 40 Male; 20 Female | 3D printed (n=10) | PEEK (n=30), Ti (n=20) | 30 | Infection (n=1), wound failure (n=1) | Infection (n=10) | Traumatic brain injury, stroke | Low risk |
| Sahoo et al, 2020, India []39 | Retrospective cohort | 156 | 36.14 | N/A | Ti (n=56) | PMMA (n=68), Ti Mesh (n=32) | 36 | Infection (n=1), exposure (n=1) | Infection (n=7), exposure (n=2) | Traumatic brain injury, stroke | Moderate risk |
| Hosameldin et al, 2021, Egypt []6 | Retrospective cohort | 66 | 24.85 | 37 Male; 29 female | 3D printed (n=16) | PEEK (n=30), Ti (n=20) | 37 | No complication | Infection (n=6) | Trauma, tumor, bone dehiscence | High risk |
| Soto et al, 2022, UK []40 | Retrospective cohort | 55 | 39.83 | 17 Female; 39 Male | PEEK (n=24) | Ti (n=18), PMMA (n=13) | 48 | Infection (n=5), healing-related problem (n=1) | Infection (n=7), implant exposure (n=2) | Trauma, tumor, infection | Moderate risk |
| Tao Ji et al, 2022, China []59 | Retrospective cohort | 130 | 47.25 | 92 Male; 38 Female | PEEK (n=100) | Ti mesh (n=30) | 32 | Subgeal effusion (n=30) | Subgeal effusion (n=51) | Trauma, tumor | Moderate risk |
| Mozaffari et al, 2022, Egypt [48 | Retrospective cohort | 66 | 51.7 | 36 Male; 30 Female | 3D-printed PEEK (n=30) | Autologous (n=36) | 28 | Infection (n=5) | Infection (n=12), implant exposure (n=5) | Trauma | High risk |
| Anderson et al, 2023, USA []34 | Retrospective cohort | 31 | 48.9 | 26 Male; 5 Female | 3D-printed PEEK (n=11) | Autologous (n=30) | 23.9 | Edema (n=3) | Infection (n=5), implant failure (n=5) | Traumatic brain injury, tumor, congenital birth defect, stroke | Moderate risk |
| Kim et al, 2023, China []11 | Retrospective cohort | 35 | 35.5 | N/A | 3D-printed Ti (15) | Ti Mesh (n=20) | N/A | Infection (n=1), implant exposure(n=1) | Infection (n=3), implant exposure (n=2), dehiscence (n=1) | Trauma, tumor | Low risk |
| Yao et al, 2023, China []41 | Retrospective cohort | 66 | 49.0 ±14.3 | 33 Female; 33 Male | 3D-printed PEEK (n=20) | Ti (n=46) | 30 | No complication | Cerebrospinal fluid leakage (n=2) | Trauma | Moderate risk |
| Abdelwahed et al, 2024, Egypt []32 | Prospective cohort | 22 | 30.8 | N/A | UHMWP (n=10) | PEEK (12) | 20.8 | Dehiscence (n=1) | dehiscence (n=1), cerebrospinal fluid (n=1) | Trauma, tumor | Moderate risk |
| HA – hydroxyapatite; PEEK – polyetheretherketone; PMMA – polymethylmethacrylate; PP – porous polyethylene; Ti – titanium; UHMWP – ultra-high molecular weight polyethylene; NOS – Newcastle-Ottawa Scale. | |||||||||||