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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

Summary

Side-by-side

A simplified view. Each row is a general characteristic, not a guarantee for any individual patient.

MaterialHow it's madeGrows into bone?ImagingKey evidence signal
Own bone (stored)Saved from craniectomyLiving bone; may resorbNormalResorption drives reoperation4,10
PMMAHand-molded or prefabricatedNoMinimal interferenceMixed; higher infection in some NMAs11,12,13
PEEKPatient-specificNoMinimal interferenceLowest revision in one NMA6
Titanium meshBent in surgeryLimitedSome CT artifactFewer hematomas, more exposure14
Titanium PSIMilled or 3D printedLimitedSome CT artifactFewer complications vs standard implants15
HydroxyapatiteCustom porous ceramicYes, designed to integrateMinimal interferenceIntegration, but brittle18,19
Porous polyethyleneSheets or customSoft-tissue ingrowthMinimal interferenceLow complications, mostly non-comparative data20

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. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. Staffa G, et al. Custom made bioceramic implants in complex and large cranial reconstruction: a two-year follow-up. J Craniomaxillofac Surg. 2012;40(3):e65-70. doi:10.1016/j.jcms.2011.04.014
  10. Ganau M, et al. Surgical preference regarding different materials for custom-made allograft cranioplasty: results from an internal audit covering the last 20 years. J Clin Neurosci. 2020;74:98-103. doi:10.1016/j.jocn.2020.01.087
  11. Perozzo FAG, et al. High-density porous polyethylene implant cranioplasty: a systematic review of outcomes. J Craniofac Surg. 2024;35(4):1074-1079. doi:10.1097/SCS.0000000000010135

All references