Comparison of autologous and custom-made titanium cranioplasty following decompressive craniectomy for traumatic brain injury: A 7-year clinical experience.

BACKGROUND

Traumatic brain injury (TBI) is one of the common reasons for decompressive craniectomy (DC). The management of DC must include cranioplasty procedures. Although both procedures may cause several complications, postoperative outcomes are of greater concern for patients. The timing of cranioplasty (CP) and the type of CP material are the main parameters evaluated retrospectively in this report in terms of their impact on postoperative complications and cosmetic results.

METHODS

A total of 47 patients who underwent autologous cranioplasty (n=22) or custom-made titanium cranioplasty (n=25) due to TBI between January 2017 and January 2024 in our department were retrospectively analyzed. The groups were compared in terms of demographic characteristics, complication rates, and operative parameters. Cosmetic results and one-year mortality rates were also reported. The Odom criteria were used for the assessment of cosmetic results.

RESULTS

Baseline characteristics and overall complication rates did not differ significantly between the groups. Blood loss was significantly lower in titanium cranioplasty compared to autologous cranioplasty (126.2+-47.9 ml vs. 215.5+-35.6 ml, p<0.001). The highest complication rate was observed in cranioplasties performed 3-6 months after DC. In the early period (<3 months), autologous grafts were associated with significantly more complications than titanium (5/7 vs. 0/7, p=0.021). Cosmetic outcomes were significantly better with titanium, while timing had no effect on cosmetic results. One-year mortality rates were similar between the groups.

CONCLUSION

The timing of cranioplasty and the type of cranioplasty material may influence postoperative outcomes in patients with TBI. Titanium plates could be a preferable option for early cranioplasty if autologous bone cannot be used for reconstruction, whereas late cranioplasty appears to be associated with fewer complications overall. Further studies are needed to support these findings.