Titanium Versus Autologous Bone-Based Cranioplasty: A Systematic Review and Meta-Analysis

Area of Science:

• Neurosurgery
• Biomaterials Science
• Plastic Surgery

Background:

• Cranioplasty lacks a gold standard for reconstructive materials.
• Titanium is a promising synthetic option due to its strength and biocompatibility.
• Existing comparative studies on titanium vs. autologous bone for cranioplasty need synthesis.

Purpose of the Study:

• To systematically review and meta-analyze comparative studies of autologous bone versus titanium implants in cranioplasty.
• To provide evidence-based guidelines for craniofacial surgeons regarding material choice.

Main Methods:

• Systematic review and meta-analysis conducted following PRISMA guidelines.
• Searched electronic databases for comparative studies of autologous bone vs. titanium in cranioplasty.
• Included five studies with a total of 323 cases, analyzing re-operation rates, cosmesis, bone resorption, infection, and costs.

Main Results:

• Autologous bone cranioplasty exhibited a significantly higher re-operation rate (p > 0.007) primarily due to bone resorption.
• No significant differences were observed in cosmetic outcomes between titanium and autologous bone groups.
• Infection rates and postoperative costs were comparable between the two reconstructive materials (p > 0.18).

Conclusions:

• Titanium implants offer a reduced re-operation rate compared to autologous bone grafts for cranioplasty.
• Titanium demonstrates comparable safety and aesthetic profiles to autologous bone, without significant increases in adverse outcomes.
• The findings support titanium as a viable alternative to autologous bone in cranioplasty procedures.