Abstract
Background: Decompressive craniectomy (DC) is a life-saving procedure for neurocritical patients with conditions such as severe traumatic brain injury (TBI), ischemic stroke, and subarachnoid haemorrhage. However, it results in cranial defects that necessitate cranioplasty to restore skull integrity, protect brain function, and address cosmetic concerns. The choice of material—autologous bone (AB) or artificial materials like titanium mesh (TM)—remains controversial due to varying complication rates.
Methods: This comparative cross-sectional study evaluated 23 patients who underwent cranioplasty with AB (n=5) or TM (n=18) between January 2022 and March 2025 at SVP Hospital and NHL Medical College, Ahmedabad. Data on demographics, surgical timing, complications, and outcomes were analyzed. Complications included infections, bone flap resorption (BFR), wound dehiscence, and cosmetic outcomes.
Results: The overall complication rate was 43.47% (AB group: 80%, TM group: 33.33%). BFR occurred exclusively in the AB group (40%), while TM-related complications included surgical site infections, wound dehiscence, and persistent tenderness. Wound dehiscence and multiple bone fragments were significant risk factors for post-cranioplasty infections and BFR, respectively. Cosmetic satisfaction was comparable between groups (82.60% overall), but TM demonstrated shorter operation times, reduced bleeding, and shorter hospital stays.
Conclusion: Cranioplasty using TM showed advantages over AB in terms of lower complication rates, reduced operative time, and improved hospitalisation outcomes. However, TM was associated with higher minor complications like wound dehiscence. For patients with larger bone defects, artificial materials may reduce BFR risks. Further prospective randomised trials are needed to validate these findings and optimise cranioplasty outcomes.
