A patient and clinician guide to skull reconstruction

Cranioplasty, explained

What the operation is, why it matters for the brain as well as appearance, how it is done, and an evidence-based look at every major material used to rebuild the skull.

Side view of a skull with a missing section and an implant shaped to fill it implant skull defect
Schematic only. Real defects vary widely in size and location.
Reading as
Plain-language core. Switch lenses to reveal technical or purchasing detail.

Overview

What is cranioplasty?

Cranioplasty is surgery to repair an opening or defect in the skull. Most often it follows a decompressive craniectomy, an emergency operation in which surgeons remove part of the skull so a swollen brain has room to expand. That first operation can be lifesaving after a severe head injury, a large stroke, bleeding in the brain, or infection. Once the swelling settles, the missing section needs to be replaced.

Defects can also come from tumor removal, infected bone that had to be taken out, a bone flap that broke down over time, or problems present from birth.

The missing piece can be rebuilt with the patient's own bone (called autologous) or with a manufactured material (called alloplastic). This guide focuses on the alloplastic options, with the patient's own bone included as the reference point most comparisons use.

Clinical detail

Typical indications include post-decompressive defects after TBI, malignant MCA infarction, ICH and aneurysmal SAH, as well as post-oncologic resection, osteomyelitis with flap removal, and aseptic bone flap resorption after prior autologous cranioplasty. In a systematic review of syndrome of the trephined, TBI was the most common indication for the preceding craniectomy (43%), followed by tumor resection (23%).2

Purpose

Why it matters beyond appearance

Restoring the shape of the head is important, and so is protecting the brain from injury. But cranioplasty can also help how the brain works. Without bone covering it, the brain is exposed to atmospheric pressure through the scalp, and blood and fluid flow can be disturbed.

Some patients develop the syndrome of the trephined (also called sinking skin flap syndrome): the scalp sinks inward and the person gets worse, with weakness, reduced alertness, mood changes, speech problems or headache. Cranioplasty can reverse these symptoms.2

Clinical detail
  • A systematic review of 21 studies (205 patients) measuring cerebral hemodynamics before and after cranioplasty found that every study showed increased cerebral blood flow on the side of the repair, and 9 of 21 also showed a contralateral increase. Most patients improved neurologically, though causality between CBF and function is not established.1
  • In a review of 56 reconstructed SoT patients, the most common deficits were motor (52%) and reduced wakefulness (30%). Symptoms appeared a mean of 4.4 months after decompression, and TBI was a risk factor (adjusted OR 8.2). Time to neurological improvement did not differ between autologous and alloplastic reconstruction.2

When

When is cranioplasty done?

There is no single right time. The surgeon waits until brain swelling has resolved, the scalp wound has healed, and there is no sign of infection. Beyond that, timing depends on the patient's overall recovery and on whether problems like the syndrome of the trephined call for repair sooner.

Research has not settled whether earlier or later is better overall. Doing it earlier seems to reduce some problems and increase others.3

Clinical detail

A 2024 meta-analysis in severe TBI found early cranioplasty (within about 35 days) associated with lower odds of subdural effusion (OR 0.37) with no difference in infection. Cranioplasty at or under 3 months was associated with fewer minor complications (OR 0.45) but higher odds of hydrocephalus (OR 3.20) and total complications (OR 1.42). The authors conclude there is no consensus on optimal timing.3

Material choice interacts with timing when the patient's own flap is used: in a series of 960 cryopreserved flaps, storage beyond 365 days was associated with higher resorption (6.88% vs 2.92%).8

How

The procedure, step by step

Details vary by surgeon and hospital, but most cranioplasties follow the same general path.

  1. Imaging and evaluationA CT scan of the head shows the size and shape of the defect. The team checks that the scalp has healed, that there is no infection, and whether fluid buildup (hydrocephalus) needs attention first.
  2. Choosing the reconstructionThe surgeon decides between the patient's stored bone flap and a manufactured implant. Manufactured implants come either as stock material shaped during surgery or as a patient-specific implant designed in advance from the CT scan.
  3. Implant design (if patient-specific)Engineers convert the CT into a 3D model and design an implant that matches the missing contour, usually by mirroring the healthy side. The surgeon reviews and approves the design before it is made.
  4. SurgeryUnder general anesthesia, the surgeon reopens the previous incision, gently separates the scalp from the protective layer over the brain (the dura), and exposes the bone edges around the defect.
  5. Fitting and fixationThe implant or bone flap is placed into the defect and secured to the surrounding skull, typically with small plates and screws. The scalp is then closed in layers, sometimes with a temporary drain.
  6. RecoveryMost patients stay in the hospital for a short period for monitoring, and many have a follow-up CT. The care team watches the wound for healing and signs of infection over the following weeks.
Value analysis

Patient-specific implants require pre-operative imaging transfer, a design review, and manufacturing lead time, so scheduling and case-approval workflows matter. Stock or hand-shaped options avoid lead time but shift fitting work into the operating room.

For patients and families

Your patient journey

Every hospital does things a little differently, and your own team's instructions always come first. This is a general picture of what most people go through, so the process feels less unfamiliar.

Before surgery

Getting ready

  • Tests and scans. Expect blood work and a CT scan of your head. Some people also have an X-ray or MRI.24 If you're getting a custom implant, that CT is what it will be designed from.
  • Medication review. Tell your team about every medicine you take, especially blood thinners such as warfarin or aspirin, and anti-inflammatory drugs. You may be asked to stop or adjust some of them.24,25
  • Stop smoking and alcohol. Your surgeon will likely ask you to stop at least a week before surgery.24 Smoking slows wound healing.
  • Possible preventive medicines. Some people are given antibiotics or anti-seizure medicine around the time of surgery.24
  • Plan for home. Arrange a ride home, someone to stay with you for the first days, and time off work or school.
Day of surgery

In the operating room

  • Anesthesia. You will be fully asleep under general anesthesia.25
  • The incision. The area is shaved, and the surgeon usually opens along your previous scar.24
  • The repair. The surgeon frees the scalp from the brain's covering, then fits your bone flap or implant into the opening and secures it.25
  • Closing. The scalp is closed with stitches or staples. A small drain may be left in for a short time.25
  • How long. Cranioplasty usually takes up to about three hours.24 Your family can ask where to wait and how they'll get updates.
After surgery

Hospital and home

  • First night. You'll be watched closely, often in a step-down unit or ICU. A mild headache is common.24,25
  • Hospital stay. Usually a few days. One center cites 2 to 3 days; another cites up to about 5 on average, longer if needed.24,25
  • Going home. Generally once you can walk, shower and dress on your own. You may have a scan before you leave.24,25
  • Follow-up visits. Often around 1 week, 1 month and 3 months, including stitch or staple removal.24,25
  • Full recovery. Usually takes 1 to 3 months.24

Tips for a smoother recovery

  • Rest, and keep your head raised on pillows rather than lying flat.24
  • Skip strenuous activity and heavy lifting until your surgeon clears you.24
  • Don't drive until your doctor says you're ready. That check often happens 1 to 2 weeks after surgery.25
  • Follow your team's wound care instructions exactly, including when you can shower and wash your hair.24
  • Take every medicine as prescribed. Never stop seizure medicine on your own.
  • Prevent falls: clear walkways, use a night light, and have someone nearby for the first days home.26
  • Keep every follow-up appointment, even if you feel fine.24
  • Stay off tobacco while you heal.

About protective helmets

Simple drawing of a soft protective helmet

Between craniectomy and cranioplasty, part of the brain has no bone over it. Patients are usually asked to wear a padded protective helmet so a fall or bump doesn't injure the unprotected area.26

  • Your care team decides when the helmet must be worn, often whenever you're up, walking, or being moved, and reviews it as you recover.27
  • Helmets are sized to your head and can be adjusted as swelling changes. Report any rubbing, red marks or discomfort right away.27
  • Clean it using the instructions that come with it.27
  • After cranioplasty, ask your surgeon when you can stop wearing it. Don't stop on your own.

Read the full helmet guide

Call your care team right away if you notice

A headache that keeps getting worse, fever, swelling or redness at the incision, or fluid leaking from the wound.24,25 Call 911 for a seizure or signs of a stroke, such as sudden weakness, face drooping, or trouble speaking.24

For patients and families

Recovery supplies

Practical things that make recovery at home safer and easier. Each category explains what to look for, so you can choose well whether or not you use the links here.

How this section is funded. As an Amazon Associate I earn from qualifying purchases. If you buy through a link here, this site earns a small commission at no extra cost to you. Commissions never decide what is included.

Check with your care team first. Your surgeon's instructions come before anything on this page, especially for helmets and anything that touches the incision.

Loading recovery supplies.

Options

Implant materials

Each material below is a real option in current practice. None is best for every patient. Defect size and location, scalp quality, prior infection, age, imaging needs, and surgeon experience all shape the choice.

The patient's own bone

Reference pointStored flapSplit calvarial graft

The piece removed during craniectomy can be frozen in a tissue bank or stored under the skin of the abdomen, then replaced later. It costs nothing to manufacture and is living tissue, but stored bone can slowly dissolve after it is put back, which is called resorption.

Strengths

  • The patient's own tissue
  • No implant manufacturing
  • Fresh, unstored bone grafts had the lowest complication rates in one meta-analysis7

Trade-offs

  • Resorption occurred in 15.1% of autologous cases and 0% of alloplastic cases in a network meta-analysis4
  • Higher resorption in children and after long storage8
  • Flap may be unusable if contaminated or fragmented
Clinical detail
  • In 960 cryopreserved flaps, resorption was 9.38% in patients 18 or younger vs 3.61% in adults; graft infection was higher after emergency craniectomy (8.81% vs 2.59%) and in diabetic patients (10.53% vs 3.07%).8 Another cryopreserved series reported 21.6% overall resorption.9
  • TBI is a risk factor for aseptic bone flap resorption (RR 1.54) and for reoperation in autologous cranioplasty (RR 1.49) but not in alloplastic cranioplasty.10
  • Note that the favorable autologous data in Oberoi et al. describe fresh, heterotopic cranial bone grafts, a different population from stored craniectomy flaps.7

PMMA (acrylic bone cement)

Hand-molded in surgeryPrefabricated, patient-specific

Polymethylmethacrylate is a hard acrylic plastic with a long history in skull repair. It can be mixed and shaped by hand during surgery, where it hardens in place, or manufactured in advance to match the patient's CT scan.

Strengths

  • Widely available and inexpensive
  • Shows little interference on CT and MRI
  • Can be made patient-specific at low cost, including in low-resource settings22

Trade-offs

  • Does not grow into bone
  • Hand-shaped fit depends on surgeon technique
  • Several analyses associate it with higher infection or re-surgery rates11,13
Clinical detail
  • Evidence is mixed. A 2018 meta-analysis (1,278 cranioplasties) found no difference in complications between PMMA and autologous bone (RR 0.98) or titanium (RR 1.59, NS).12
  • A network meta-analysis found methyl methacrylate carried 1.62 times the infection risk of autologous bone.11 A 2026 network meta-analysis of alloplasts associated PMMA with higher infection and the highest re-surgery ranking.13
  • Revision rates by format in one NMA: hand-molded 18%, prefabricated 9%.6 A single-center audit found reoperation in 28% of custom PMMA vs 6.5% of porous hydroxyapatite.19

PEEK (polyetheretherketone)

Patient-specificMachined or 3D printed

PEEK is a high-performance medical plastic. Cranial PEEK implants are made in advance from the patient's CT scan, so they arrive shaped to fit. PEEK does not block X-rays, which makes follow-up imaging easy to read.

Strengths

  • Pre-shaped to the defect
  • Very little imaging interference
  • Lowest revision rate among materials in one network meta-analysis6

Trade-offs

  • Does not grow into bone
  • Requires manufacturing lead time
  • Infection and hematoma rates still comparable to other substitutes5
Clinical detail
  • PEEK revision was 5% (8/157) with RR 0.39 vs titanium and 0.20 vs autograft in one NMA.6
  • Against titanium, PEEK had lower overall complications (OR 0.51) and implant exposure (OR 0.17), with no difference in infection or hematoma.5
  • An earlier meta-analysis of 183 PEEK patients found a trend toward fewer complications than autologous grafts and fewer failures than titanium mesh, limited by small numbers.16
  • Pooled all-cause complication rate 18.5% and failure 6.3% in studies with 12+ months follow-up.7 3D-printed PEEK showed no difference from standard implants (OR 1.02).15

Titanium

Mesh, shaped in surgeryPatient-specific milledPatient-specific 3D printed

Titanium is a strong, lightweight metal widely used in medical implants. It comes as flat mesh that the surgeon bends to shape, or as a patient-specific plate designed from the CT scan and then milled or 3D printed. Printing can build features like fixation tabs and porous structures directly into the part.

Strengths

  • High strength in a thin profile
  • Fewer hematomas and fit problems than non-titanium implants in a meta-analysis14
  • Shorter hospital stay than autologous bone in one analysis11

Trade-offs

  • Higher risk of the implant showing through the scalp (exposure)14,13
  • Causes some artifact on CT scans17
  • Hand-bent mesh fit depends on technique
Clinical detail
  • Across 2,258 procedures, titanium had lower overall complications (OR 0.72), hematoma (OR 0.31) and imprecise fitting (OR 0.35), but higher implant exposure (OR 4.11).14 Dehiscence was higher with titanium than autologous bone (RR 0.34 favoring autologous).4
  • Length of stay averaged 3.62 days shorter with titanium vs autologous bone.11 Titanium had lower reoperation than autologous bone, driven by resorption, with comparable cost and infection.21
  • A 2025 meta-analysis found 3D-printed titanium implants reduced total complications vs standard implants (OR 0.26); 3D-printed implants overall had lower infection (OR 0.33) but more effusion (OR 2.20).15 A 40-patient series of 3D-printed titanium mesh PSIs reported no complications requiring reoperation.17
  • Exposure risk is the practical counterweight: scalp thickness, prior radiation, and prior wound breakdown deserve weight in material selection.

Hydroxyapatite and bioceramics

Custom porousCalcium phosphate

Hydroxyapatite is the main mineral in natural bone. Custom porous hydroxyapatite implants are designed from CT and are built so the patient's bone can grow into them over time, a process called osseointegration.

Strengths

  • Can integrate with surrounding bone19
  • Low infection in a 2-year multicenter series18

Trade-offs

  • Brittle; can fracture with trauma18
  • Associated with higher re-surgery in a 2026 network meta-analysis13
Clinical detail
  • Of 51 patients followed 2 years with custom porous HA, one infection occurred; three implants fractured after trauma and healed spontaneously, with no spontaneous fractures.18
  • A single-center audit reported osseointegration in 69% of porous HA vs 24% of PMMA (level 3 evidence).19 HA revision rate 12% in one NMA.6

Porous polyethylene

Sheets shaped in surgeryCustom

High-density porous polyethylene is a flexible plastic with tiny interconnected pores that surrounding soft tissue can grow into. It is easy to trim and is widely used across face and skull reconstruction.

Strengths

  • Easy handling and trimming
  • Low overall complication rate in a systematic review20

Trade-offs

  • Fewer head-to-head comparisons than other materials
  • More complications in repeat operations at the same site20
Clinical detail

A 2024 systematic review of 1,104 HDPP cranioplasties (defects 3 to 340 cm²) found a 2.3% overall complication rate, higher in secondary cranioplasty, with reported patient satisfaction of 98.3% where measured. Most included studies were not comparative.20

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

US market

Manufacturers available in the United States

These companies market alloplastic cranial implants in the US. Most cranial implants reach the market through FDA 510(k) clearance as Class II devices, which is why you will usually see "FDA cleared" rather than "FDA approved."

Listed alphabetically. Compiled October 2026 from public company pages, FDA documents and press releases linked on each card. This list may not be complete and product lines change, so confirm current status in the FDA 510(k) database. Drawings show the implant material type and are not product photos; each company's site has photos of its actual products.

PEEK

3D Systems

VSP PEEK Cranial Implant

Material
PEEK
How it's made
Patient-specific, 3D printed (additive manufacturing)
US status
510(k) cleared April 2024; described as the first FDA-cleared additively manufactured PEEK cranial implant
Company websiteClearance source
Printed titanium

CGBIO

EASYMADE TI

Material
Medical-grade titanium alloy
How it's made
Patient-specific, laser powder bed fusion (metal 3D printing)
US status
510(k) clearance announced April 2026. Newly cleared; confirm US availability with the company.
Company websiteClearance source
Material not disclosed

CraniUS Therapeutics

CraniUS Plate

Material
Not specified in the public announcement
How it's made
Patient-specific; Class II preformed alterable cranioplasty plate
US status
510(k) cleared July 2026, announced September 2026. The company's broader brain-access platform remains investigational.
Company websiteClearance source
PEEK
Titanium

J&J MedTech (DePuy Synthes)

TRUMATCH CMF Patient Specific Implant

Material
PEEK; commercially pure titanium
How it's made
Patient-specific, designed from CT data
US status
Marketed on the company's US site for cranial and craniofacial bony voids
Product page
PEEK
BCP-PEEK
HA ceramic

Kelyniam Global

Custom PEEK Implants; FUSION BCP-PEEK

Material
PEEK; biphasic calcium phosphate reinforced PEEK. The site also lists hydroxyapatite (CustomizedBone) and resorbable PCL burr hole products.
How it's made
Patient-specific, made in Connecticut
US status
Custom PEEK cranial implant cleared 2011; FUSION BCP-PEEK cleared September 2025
Company websitePEEK 510(k)FUSION source
PEEK
Titanium mesh
Solid titanium

KLS Martin

IPS Implants Cranium

Material
PEEK; titanium mesh; solid titanium; additively manufactured titanium
How it's made
Patient-specific, by 3D printing or conventional milling and forming
US status
Marketed in North America through KLS Martin LP; the company notes not every product is available in every market
Product pageUS device listing
PMMA

Longeviti Neuro Solutions

ClearFit (Patient Specific and Off-the-Shelf)

Material
PMMA
How it's made
Patient-specific from CT, or off-the-shelf sterile shapes and sizes. Designed to allow ultrasound imaging through the implant after surgery.
US status
510(k) cleared December 2020 (K203349)
Company websiteFDA 510(k)
PEEK
Titanium

MedCAD

AccuShape Cranial Implants

Material
PEEK; titanium (milled grade 2, and 3D printed per company site)
How it's made
Patient-specific, designed from CT data
US status
AccuShape Titanium cleared August 2022 (K220357)
Company websiteClearance record
Printed titanium

Meticuly

Patient-Specific Titanium Cranial Mesh

Material
Titanium alloy (Ti-6Al-4V ELI)
How it's made
Patient-specific, laser powder bed fusion (metal 3D printing)
US status
510(k) clearance announced December 2021
Company websiteClearance source
PEEK
Porous PE

Stryker

Cranial iD (PEEK and MEDPOR Customized Implants)

Material
PEEK; MEDPOR porous polyethylene
How it's made
Patient-specific. PEEK offered with or without a surgeon design session; MEDPOR can be trimmed with a scalpel in surgery.
US status
Marketed on the company's US site
Product page
PEKK / PEEK
Titanium
Porous PE

Zimmer Biomet

One2One Cranial (PEKK, PEEK, Titanium)

Material
PEKK; PEEK; titanium. Also lists CranioCurve preformed mesh and Omnipore porous polyethylene.
How it's made
Patient-matched
US status
Marketed on the company's US site
Product page

PEKK (polyetherketoneketone) is a high-performance plastic from the same family as PEEK. No longer offered: OssDsign discontinued its cranial patient-specific implant business at the end of 2023 (source).

Value analysis

When comparing vendors, ask each one for its 510(k) number and cleared indications, instructions for use, design review process, typical lead time from CT to delivery, sterilization and delivery method, and pricing for stock versus patient-specific options.

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.

For hospitals

Value analysis considerations

Implant price is only one part of the cost of cranioplasty. Repeat surgery, longer hospital stays and bone banking all add cost, and so does the clinical toll on the patient.

Evidence relevant to value
  • Reoperation avoidance. Revision rates ranged from 5% (PEEK) to 19% (autograft) in one network meta-analysis.6 Each revision is a second procedure with its own OR, implant, and inpatient costs.
  • Length of stay. Titanium was associated with a 3.62-day shorter stay than autologous bone.11
  • High-risk subgroups. Pediatric patients, TBI patients, and flaps stored more than a year carry higher resorption risk with autologous bone.8,10 TBI did not raise reoperation risk with alloplastic implants.10
  • Cost comparisons are limited. One meta-analysis found titanium and autologous costs comparable.21 Very low-cost in-house patient-specific methods have been described outside the US regulatory setting.22,23
Questions for a value analysis committee
  • What is our case mix by indication (TBI, stroke, tumor, infection) and by patient age?
  • What are our current revision, infection and resorption rates, and what does a revision cost us?
  • Do we bank bone flaps, and what does storage and handling cost per case?
  • Which defects need patient-specific design, and what manufacturing lead time can our scheduling absorb?
  • Is each product FDA cleared for cranial reconstruction, and what is its regulatory pathway?
  • Which materials do our surgeons have experience with, and for which patients would each be preferred?

Switch the lens above to Value analysis to see hospital purchasing considerations.

For patients and families

Questions to ask your surgeon

  1. Why do you recommend repairing my skull now, and what happens if we wait?
  2. Is my own bone flap available and usable? If so, what is my risk of it resorbing?
  3. Which implant material do you recommend for me, and why that one?
  4. Will the implant be made specifically for me from my CT scan, or shaped during surgery?
  5. How thin is my scalp over the defect, and does that change which material is safest?
  6. What are the signs of infection or other problems I should watch for after surgery?
  7. Will the implant affect future CT or MRI scans?
  8. How many of these operations do you do each year, and with which materials?

Terms

Glossary

Craniectomy
Surgery that removes part of the skull and leaves it out, usually to relieve brain swelling.
Craniotomy
Surgery that removes part of the skull and puts it back during the same operation.
Cranioplasty
Surgery to repair a defect in the skull.
Autologous
From the patient's own body.
Alloplastic
Made from a manufactured, non-biological material.
Patient-specific implant (PSI)
An implant designed from a patient's own CT scan to match the defect.
Dura
The tough protective membrane covering the brain.
Resorption
Gradual breakdown and loss of replaced bone.
Osseointegration
Bone growing into and bonding with an implant surface.
Exposure or dehiscence
The wound opening or the implant becoming visible through thin scalp.
Syndrome of the trephined
Neurological decline after craniectomy that can improve once the skull is repaired.

Sources

References

Sources 1 to 23 are peer-reviewed articles retrieved from PubMed, each linked to its DOI. Sources 24 to 27 are hospital patient-education pages. Manufacturer sources are linked on each manufacturer card.

  1. Halani SH, et al. Effects of cranioplasty on cerebral blood flow following decompressive craniectomy: a systematic review. Neurosurgery. 2017;81(2):204-216. doi:10.1093/neuros/nyx054
  2. Mustroph CM, et al. Systematic review of syndrome of the trephined and reconstructive implications. J Craniofac Surg. 2022;33(6):e647-e652. doi:10.1097/SCS.0000000000008724
  3. Palavani LB, et al. Timing matters: a comprehensive meta-analysis on the optimal period for cranioplasty after severe TBI. Oper Neurosurg. 2025;29(1):1-18. doi:10.1227/ons.0000000000001404
  4. 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
  5. Liu L, et al. Comparison of complications in cranioplasty with various materials: a systematic review and meta-analysis. Br J Neurosurg. 2020;34(4):388-396. doi:10.1080/02688697.2020.1742291
  6. 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
  7. 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
  8. Fan MC, et al. Cryopreservation of autologous cranial bone flaps for cranioplasty: a large sample retrospective study. World Neurosurg. 2018;109:e853-e859. doi:10.1016/j.wneu.2017.10.112
  9. Mirabet V, et al. Cranioplasty with autologous bone flaps cryopreserved with dimethylsulphoxide: does tissue processing matter. World Neurosurg. 2021;149:e582-e591. doi:10.1016/j.wneu.2021.01.131
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. Punchak M, et al. Outcomes following polyetheretherketone (PEEK) cranioplasty: systematic review and meta-analysis. J Clin Neurosci. 2017;41:30-35. doi:10.1016/j.jocn.2017.03.028
  17. Yoon HG, et al. Efficacy of 3D-printed titanium mesh-type patient-specific implant for cranioplasty. Korean J Neurotrauma. 2021;17(2):91-99. doi:10.13004/kjnt.2021.17.e25
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