{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T01:03:39Z","timestamp":1780448619653,"version":"3.54.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n Cranioplasty 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.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n 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.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE2694<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case2694","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:56Z","timestamp":1779840056000},"source":"Crossref","is-referenced-by-count":0,"title":["Displacement of synthetic cranioplasty implant due to mechanical failure of titanium fixation plating: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3144-9191","authenticated-orcid":true,"given":"Graham A.","family":"Branscom","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan M.","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Lemonick","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9729-9122","authenticated-orcid":true,"given":"Bahie","family":"Ezzat","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3545-796X","authenticated-orcid":true,"given":"Ziad","family":"Rifi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2971-6216","authenticated-orcid":true,"given":"Shahram","family":"Majidi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4604-8205","authenticated-orcid":true,"given":"Christopher P.","family":"Kellner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3463-0222","authenticated-orcid":true,"given":"Tomoyoshi","family":"Shigematsu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"World Neurosurg","first-page":"445","article-title":"Cranioplasty: a comprehensive review of the history, materials, surgical aspects, and complications","volume":"139","author":"Alkhaibary","year":"2020","unstructured":"Alkhaibary AAlharbi AAlnefaie NOqalaa Almubarak AAloraidi AKhairy S.Cranioplasty: a comprehensive review of the history, materials, surgical aspects, and complications. World Neurosurg. 2020;139:445-452. doi:10.1016\/j.wneu.2020.04.211"},{"issue":"2","key":"bib2","series-title":"Neurosurg Clin N Am","first-page":"257","article-title":"Cranioplasty","volume":"28","author":"Piazza","year":"2017","unstructured":"Piazza MGrady MS.Cranioplasty. Neurosurg Clin N Am. 2017;28(2):257-265. doi:10.1016\/j.nec.2016.11.008"},{"issue":"3","key":"bib3","series-title":"Neurocrit Care","first-page":"456","article-title":"Decompressive craniectomy","volume":"8","author":"Schirmer","year":"2008","unstructured":"Schirmer CMAckil AAMalek AM.Decompressive craniectomy. Neurocrit Care. 2008;8(3):456-470. doi:10.1007\/s12028-008-9082-y"},{"issue":"1","key":"bib4","series-title":"J Oral Biol Craniofac Res","first-page":"66","article-title":"Failures in cranioplasty\u2014a clinical audit & review","volume":"11","author":"Sahoo","year":"2021","unstructured":"Sahoo NKTomar KThakral AKumar S.Failures in cranioplasty\u2014a clinical audit & review. J Oral Biol Craniofac Res. 2021;11(1):66-70. doi:10.1016\/j.jobcr.2020.11.013"},{"issue":"1","key":"bib5","series-title":"3D Print Med","first-page":"14","article-title":"A retrospective descriptive study of cranioplasty failure rates and contributing factors in novel 3D printed calcium phosphate implants compared to traditional materials","volume":"6","author":"Koller","year":"2020","unstructured":"Koller MRafter DShok GMurphy SKiaei SSamadani U.A retrospective descriptive study of cranioplasty failure rates and contributing factors in novel 3D printed calcium phosphate implants compared to traditional materials. 3D Print Med. 2020;6(1):14. doi:10.1186\/s41205-020-00066-5"},{"issue":"7","key":"bib6","series-title":"Cureus","first-page":"e16795","article-title":"Characterizing adverse events of cranioplasty implants after craniectomy: a retrospective review of the federal manufacturer and user facility device experience database","volume":"13","author":"Hacherl","year":"2021","unstructured":"Hacherl CCPatel NAJones KCharacterizing adverse events of cranioplasty implants after craniectomy: a retrospective review of the federal manufacturer and user facility device experience database. Cureus. 2021;13(7):e16795. doi:10.7759\/cureus.16795"},{"issue":"2","key":"bib7","series-title":"Neurosurgery","first-page":"248","article-title":"Cranioplasty with custom-made titanium plates\u201414 years experience","volume":"72","author":"Wiggins","year":"2013","unstructured":"Wiggins AAusterberry RMorrison DHo KMHoneybul S.Cranioplasty with custom-made titanium plates\u201414 years experience. Neurosurgery. 2013;72(2):248-256. doi:10.1227\/neu.0b013e31827b98f3"},{"issue":"2","key":"bib8","series-title":"Craniomaxillofac Trauma Reconstr","first-page":"158","article-title":"Deformation of a titanium calvarial implant following trauma: a case report","volume":"9","author":"De Water","year":"2015","unstructured":"De Water VRRubio EJDSSchouten JWKoudstaal MJ.Deformation of a titanium calvarial implant following trauma: a case report. 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J Clin Neurosci. 2017;41:30-35. doi:10.1016\/j.jocn.2017.03.028"},{"issue":"3","key":"bib15","series-title":"Br J Neurosurg","first-page":"385","article-title":"Cranioplasty with hydroxyapatite or acrylic is associated with a reduced risk of all-cause and infection-associated explantation","volume":"36","author":"Millward","year":"2022","unstructured":"Millward CPDoherty JAMustafa MACranioplasty with hydroxyapatite or acrylic is associated with a reduced risk of all-cause and infection-associated explantation. Br J Neurosurg. 2022;36(3):385-393. doi:10.1080\/02688697.2022.2077311"},{"issue":"1","key":"bib16","series-title":"Neurosurgery","first-page":"E15","article-title":"A retrospective comparative analysis of titanium mesh and custom implants for cranioplasty","volume":"86","author":"Rosinski","year":"2020","unstructured":"Rosinski CLPatel SGeever BA retrospective comparative analysis of titanium mesh and custom implants for cranioplasty. Neurosurgery. 2020;86(1):E15-E22. doi:10.1093\/neuros\/nyz358"},{"issue":"9","key":"bib17","series-title":"J Craniomaxillofac Surg","first-page":"1266","article-title":"Outcome in patient-specific PEEK cranioplasty: a two-center cohort study of 40 implants","volume":"44","author":"Jonkergouw","year":"2016","unstructured":"Jonkergouw Jvan de Vijfeijken SECMNout EOutcome in patient-specific PEEK cranioplasty: a two-center cohort study of 40 implants. J Craniomaxillofac Surg. 2016;44(9):1266-1272. doi:10.1016\/j.jcms.2016.07.005"},{"key":"bib1","series-title":"World Neurosurg","first-page":"445","article-title":"Cranioplasty: a comprehensive review of the history, materials, surgical aspects, and complications","volume":"139","author":"Alkhaibary","year":"2020","unstructured":"Alkhaibary AAlharbi AAlnefaie NOqalaa Almubarak AAloraidi AKhairy S.Cranioplasty: a comprehensive review of the history, materials, surgical aspects, and complications. 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J Oral Biol Craniofac Res. 2021;11(1):66-70. doi:10.1016\/j.jobcr.2020.11.013"},{"issue":"1","key":"bib5","series-title":"3D Print Med","first-page":"14","article-title":"A retrospective descriptive study of cranioplasty failure rates and contributing factors in novel 3D printed calcium phosphate implants compared to traditional materials","volume":"6","author":"Koller","year":"2020","unstructured":"Koller MRafter DShok GMurphy SKiaei SSamadani U.A retrospective descriptive study of cranioplasty failure rates and contributing factors in novel 3D printed calcium phosphate implants compared to traditional materials. 3D Print Med. 2020;6(1):14. doi:10.1186\/s41205-020-00066-5"},{"issue":"7","key":"bib6","series-title":"Cureus","first-page":"e16795","article-title":"Characterizing adverse events of cranioplasty implants after craniectomy: a retrospective review of the federal manufacturer and user facility device experience database","volume":"13","author":"Hacherl","year":"2021","unstructured":"Hacherl CCPatel NAJones KCharacterizing adverse events of cranioplasty implants after craniectomy: a retrospective review of the federal manufacturer and user facility device experience database. Cureus. 2021;13(7):e16795. doi:10.7759\/cureus.16795"},{"issue":"2","key":"bib7","series-title":"Neurosurgery","first-page":"248","article-title":"Cranioplasty with custom-made titanium plates\u201414 years experience","volume":"72","author":"Wiggins","year":"2013","unstructured":"Wiggins AAusterberry RMorrison DHo KMHoneybul S.Cranioplasty with custom-made titanium plates\u201414 years experience. Neurosurgery. 2013;72(2):248-256. doi:10.1227\/neu.0b013e31827b98f3"},{"issue":"2","key":"bib8","series-title":"Craniomaxillofac Trauma Reconstr","first-page":"158","article-title":"Deformation of a titanium calvarial implant following trauma: a case report","volume":"9","author":"De Water","year":"2015","unstructured":"De Water VRRubio EJDSSchouten JWKoudstaal MJ.Deformation of a titanium calvarial implant following trauma: a case report. 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Int J Emerg Med. 2021;14(1):75. doi:10.1186\/s12245-021-00401-5"},{"issue":"1","key":"bib11","series-title":"Sci Rep","first-page":"18143","article-title":"Comparison of the mechanical properties of biodegradable and titanium osteosynthesis systems used in oral and maxillofacial surgery","volume":"10","author":"Gareb","year":"2020","unstructured":"Gareb BRoossien CCvan Bakelen NBComparison of the mechanical properties of biodegradable and titanium osteosynthesis systems used in oral and maxillofacial surgery. Sci Rep. 2020;10(1):18143. doi:10.1038\/s41598-020-75299-9"},{"key":"bib12","series-title":"World Neurosurg","first-page":"e814","article-title":"Incidence and risk factors for skull implant displacement after cranial surgery","volume":"126","author":"Rashidi","year":"2019","unstructured":"Rashidi AAdolf DKaragiannis DMelhem OBLuchtmann M.Incidence and risk factors for skull implant displacement after cranial surgery. 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