Polyetheretherketone (PEEK) in Cranial Vault Reconstruction: A Review of Alloplastic Materials, Clinical Performance, and Institutional Experience.

Cranial vault reconstruction is a critical component of care following trauma, decompressive craniectomy, infection, or oncologic resection. Large and complex cranial defects present unique reconstructive challenges, as autologous reconstruction may be limited by donor availability, contour mismatch, and long-term resorption. Consequently, alloplastic materials have become central to contemporary cranioplasty. Advances in imaging, computer-aided design/manufacturing (CAD/CAM), and three-dimensional workflows have enabled increasingly accurate patient-specific reconstruction with improved operative efficiency. This narrative perspective summarizes the evolution and clinical application of commonly used alloplastic materials in cranial vault reconstruction, including titanium, polymethylmethacrylate (PMMA), and hydroxyapatite (HA), with a focused discussion of polyetheretherketone (PEEK). We discuss the design rationale, material properties, and clinical performance of PEEK, emphasizing bone-mimicking elasticity, radiolucency, and compatibility with CAD/CAM workflows. Institutional experience is integrated to contextualize durability, aesthetic restoration, neurologic improvement, infection management, and technical considerations that influence outcomes. Overall, PEEK represents a versatile option for large and complex cranial reconstruction by combining favorable mechanical performance with patient-specific design capability. Continued advances in biomaterials and surgical planning, coupled with rigorous long-term outcome evaluation, will further refine material selection and optimize reconstructive outcomes in cranial vault reconstruction.