Intraoperative Techniques to Prevent Epidural Effusion in Cranioplasty With Polyether Ether Ketone (PEEK) Implants

PURPOSE: Epidural effusion (EE) remains a prevalent complication following cranioplasty utilizing polyether ether ketone (PEEK). While PEEK is widely adopted, intraoperative strategies specifically designed to mitigate EE are underreported. This study describes a technical modification aimed at improving drainage and reducing epidural effusion. METHODS: We conducted a retrospective single-surgeon consecutive case series. This was a retrospective, single-surgeon, consecutive case series. We reviewed all patients who underwent PEEK cranioplasty at the Department of Neurosurgery, Anhui No. 2 Provincial People's Hospital between September 2020 and October 2020. Inclusion criteria were: (1) previous decompressive craniectomy with skull defect; (2) secondary cranioplasty using patient-specific PEEK implants; (3) available perioperative imaging and ≥1-month follow-up. Exclusion criteria: active infection, shunt dependency, or incomplete records. Three patients met these criteria. Intraoperative data, including operation time, estimated blood loss, and dural injury, were extracted from operative notes. RESULTS: Postoperative epidural effusion was observed in 2 cases managed with conventional drainage placement. In contrast, no epidural fluid accumulation was detected in the patient treated with the modified epidural drainage technique. No differences were observed in operative time, blood loss, wound healing, or cosmetic satisfaction. CONCLUSION: Placement of a negative-pressure drainage tube beneath the PEEK implant, combined with appropriate implant modification, may represent a feasible intraoperative strategy to improve epidural drainage and reduce postoperative epidural effusion. Larger prospective studies are required to validate these preliminary findings.