What Is The Best Material For Occipital Augmentation?

Q: Dr. Eppley, I am interested in occipital augmentation. I have a flattened head at the back which is also assymetrical. It has been a major problem for me for many years. Isolation and depression are the main effects. I have a local surgeon who is tells me a PEEK onlay is the best option. Would you consider this to be better than a filler material. He tells me I will have a transcranial scar and will have to have my hair cut short, preferably shaved. The argument for the onlay is it is difficult to achieve a smooth transition with filler material. I should add he has never done this operation before. Could you give me any advice. I am a little nervous about head shave and a huge incision.

A: After having performed over 100 occipital augmentations with every known material (except PEEK) and method, I can tell you for certain I would never use a hard preformed material like PEEK. (or preformed HTR or preformed acrylic for that matter) The material on insertion is too hard and this requires a maximal incision to get it into place. That may be fine but I don’t know of too many patients that want a full coronal incision for their occipital augmentation.

The two most commonly used and preferred cranioplasty materials in my practice are either intraoperatively fashioned PMMA bone cement or a preformed silicone implant. Either of these materials can be placed with much smaller incisions and work well. I have not seen an infection with either cranial augmentation material to date. This does not mean these methods are perfect (PMMA can have some edge transition issues because of its intraoperative fashioning) but these issues are aesthetic and not of any major medical significance.

FYI, I do not have my patients shave any hair for their skull augmentation regardless of the material or approach.

Dr. Barry Eppley

Indianapolis, Indiana