Projects

Background: Cranioplasty following decompressive craniectomy is a common neurosurgical procedure aimed at restoring cranial contour and protecting the brain. The choice between autologous bone flap and alloplastic materials like titanium remains debated, with concerns over autologous bone flap resorption and infection being prominent. Objective: This study aimed to compare the outcomes of autologous bone flap cranioplasty versus titanium mould cranioplasty, specifically focusing on rates of infection and bone flap resorption.

 Methods: A retrospective study was conducted on 150 patients who underwent cranioplasty at St Johns Medical College between December 2023 and July 2025. Patients were divided into two groups: those receiving autologous bone flap cranioplasty (n=40) and those receiving titanium mould cranioplasty (n=110). Data on demographics, underlying pathology, cranioplasty complications (specifically infection and resorption rates), and reoperation rates were collected and analyzed. Statistical comparisons between groups were made using Fisher’s exact test and chi-square tests where appropriate, with significance set at p<0.05. 

Results: Of the 150 patients included, 40 received autologous cranioplasty and 110 received titanium mould cranioplasty. The autologous group demonstrated a significantly higher infection rate of 17.5% (7/40) compared to 5.5% (6/110) in the titanium mould group (p=0.042). Furthermore, bone flap resorption was observed in 10% (4/40) of the autologous group, necessitating reoperation in all these cases, whereas no cases of resorption were observed in the titanium mould group (0/110) (p=0.0045). Additionally, the overall complication rate was notably higher in the autologous group (27.5%, 11/40) relative to the titanium group (5.5%, 6/110) (p=0.0005). The majority of titanium patients (94.5%, 104/110) experienced an uneventful postoperative course compared to 72.5% (29/40) in the autologous cohort. Conclusion: Our findings indicate that titanium mould cranioplasty offers superior outcomes compared to autologous bone flap cranioplasty, with significantly lower rates of infection and a complete absence of bone flap resorption. These data challenge previous assumptions regarding infection equivalency between materials and underscore the durability and reliability of titanium implants. We recommend preferential consideration of titanium cranioplasty, especially in patients at risk for bone gr