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All topics
  1. What it is
  2. Why it matters
  3. Timing
  4. The procedure
  5. Patient journey
  6. Recovery supplies
  7. Implant materials
  8. Side-by-side
  9. US manufacturers
  10. What the evidence says
  11. Value analysis
  12. Questions to ask
  13. Glossary
  14. Resources
  15. References

Research

What the evidence says

Cranioplasty is common, but it carries real risk. Across studies, about 1 in 7 cases needs another operation.6

14%
pooled revision surgery rate, 2,032 cases6
8%
pooled infection rate, 4,667 cases6
6%
pooled implant exposure, 1,651 cases6
Agreement

No material wins on every outcome. Each analysis finds trade-offs, and the authors repeatedly call for prospective trials.6,11,15

Agreement

Stored autologous bone has more complications than synthetic options mainly because of resorption. With resorption set aside, overall complication rates look similar.4

Agreement

Titanium trades fewer hematomas and fit problems for more scalp exposure.4,13,14

Disagreement

PMMA looks equivalent to other options in one meta-analysis and riskier for infection or re-surgery in others.11,12,13

Disagreement

One meta-analysis of fresh, unstored bone grafts found lower complications than every synthetic material, the reverse of studies on stored flaps.7

Emerging

Patient-specific, 3D-printed implants are associated with fewer complications and infections than standard implants, with the clearest signal for titanium.15

Reading the literature

Nearly all of this evidence comes from single-center retrospective series pooled in meta-analyses with substantial heterogeneity and wide confidence intervals.11 Comparisons are confounded by indication (TBI patients carry different risk10), defect size, timing, and the fact that alloplasts are often chosen after an autologous flap has already failed. Treat material-level rates as directional.

Sources for this page

  1. Gerstl JVE, et al. Complications and cosmetic outcomes of materials used in cranioplasty following decompressive craniectomy: systematic review, pairwise and network meta-analysis. Acta Neurochir. 2022;164(12):3075-3090. doi:10.1007/s00701-022-05251-5
  2. Henry J, et al. Complications of cranioplasty in relation to material: systematic review, network meta-analysis and meta-regression. Neurosurgery. 2021;89(3):383-394. doi:10.1093/neuros/nyab180
  3. Oberoi MK, et al. Complications and failures of autologous heterotopic cranial bone versus alloplastic cranioplasties. Plast Reconstr Surg. 2024;154(4):757e-772e. doi:10.1097/PRS.0000000000011093
  4. Henry J, et al. Complications of cranioplasty following decompressive craniectomy for traumatic brain injury: systematic review and meta-analysis. Acta Neurochir. 2021;163(5):1423-1435. doi:10.1007/s00701-021-04809-z
  5. Khalid SI, et al. Materials used in cranial reconstruction: a systematic review and meta-analysis. World Neurosurg. 2022;164:e945-e963. doi:10.1016/j.wneu.2022.05.073
  6. Leão RS, et al. Complications with PMMA compared with other materials used in cranioplasty: a systematic review and meta-analysis. Braz Oral Res. 2018;32:e31. doi:10.1590/1807-3107bor-2018.vol32.0031
  7. Samandar AF, et al. Complications of alloplastic graft materials used in cranioplasty: systematic review and network meta-analysis. Med Sci Monit. 2026;32:e950551. doi:10.12659/MSM.950551
  8. Zhu S, et al. Complications following titanium cranioplasty compared with nontitanium implants cranioplasty: a systematic review and meta-analysis. J Clin Neurosci. 2021;84:66-74. doi:10.1016/j.jocn.2020.12.009
  9. Di Cosmo L, et al. Meta-analyses of the surgical outcomes using personalized 3D-printed titanium and PEEK vs. standard implants in cranial reconstruction. Neurosurg Rev. 2025;48(1):312. doi:10.1007/s10143-025-03470-9

All references