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Cranioplasty Approaches and Outcomes in Low-Middle Income Countries: A Systematic Review.

Santana S Solomon¹, Eujung Park¹, Robert Unger¹

¹University of Arizona College of Medicine-Phoenix, Phoenix.

The Journal of Craniofacial Surgery

|May 1, 2025

Summary

Cranioplasty in low- and middle-income countries (LMIC) predominantly uses cost-effective autologous bone and PMMA implants. Surgical outcomes demonstrate complication rates comparable to those reported in high-income countries.

Keywords:

Cranioplasty PEEK PMMA low-middle income countries

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Area of Science:

Neurosurgery
Medical Technology
Global Health

Background:

Cranioplasty procedures are often prohibitively expensive in low- and middle-income countries (LMIC).
Access to advanced surgical techniques and materials is limited in resource-constrained settings.
Understanding cranioplasty practices in LMIC is crucial for improving patient outcomes.

Purpose of the Study:

To systematically review surgical techniques and patient outcomes for cranioplasty in LMIC.
To identify common etiologies for cranial defects requiring reconstruction in LMIC.
To evaluate the materials and complication rates associated with cranioplasty in LMIC.

Main Methods:

A systematic review adhering to PRISMA guidelines was performed.
Studies published in PubMed, Embase, and Cochrane databases were searched.
Eighteen studies involving 541 patients undergoing cranioplasty in LMIC were included.

Main Results:

Nonspecific head trauma was the leading cause for cranioplasty (243 patients), followed by infarcts (47 patients) and vascular injuries (33 patients).
Autologous bone (62.8%) and polymethylmethacrylate (PMMA) (24.8%) were the most frequently used materials.
The overall complication rate was 17.5%, with infection (5.1%) and wound dehiscence (2.44%) being the most common.

Conclusions:

Autologous bone flaps and PMMA implants are favored in LMIC due to availability and cost-effectiveness.
Cranioplasty in LMIC yields complication rates similar to those reported in US-centric literature.
These findings highlight the feasibility of effective cranioplasty in resource-limited settings.