Displacement of synthetic cranioplasty implant due to mechanical failure of titanium fixation plating: illustrative case.

backgroundCranioplasty is a common procedure following decompressive craniectomy for traumatic brain injury or stroke, among other reasons, in order to repair a skull defect. Cranioplasty failure is an infrequent occurrence, but in the case of synthetic implants, it is usually caused by infection and incorrect sizing. However, trauma-induced displacement, breakage, and deformities of cranioplasty implants are less common. OBSERVATIONS: The authors present a unique case of a cranioplasty failure due to displacement of a polyetheretherketone (PEEK) implant secondary to catastrophic breakage of the titanium fixation plates. The cause of displacement is unknown but is suspected to be trauma. A subsequent review of the literature contextualizes common reasons for failure among synthetic implants and suggests that fracture of synthetic implants or their fixation plates is extremely rare. LESSONS: The displacement of a PEEK cranioplasty implant due to breakage of titanium fixation plates is a rare, albeit possible, complication of this neurosurgical procedure. Lifestyle modifications are paramount to reduce trauma risk and resultant cranioplasty failure. The addition of miniplates may also reduce implant displacement risk. Finally, since rates of failure differ by material, careful consideration of the type of material used for the implant should be incorporated into neurosurgical planning. https://thejns.org/doi/10.3171/CASE2694.