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

The majority of techniques to perform cranioplasty can be expensive, especially for patients and surgeons in low-income and middle-income countries (LMIC). The purpose of this study is to perform a systematic review outlining surgical techniques and outcomes of cranioplasty in LMIC.

A systematic review was conducted according to PRISMA guidelines. All studies describing cranioplasty procedures in developing countries or LMIC as self-described in papers or defined by the United Nations' published "List of Least Developed Countries." A search of PubMed, Embase, and Cochrane, yielded 59 studies. In total, 18 studies were included in the systematic review.

In total, 541 patients were included, with a mean age of 28.3 years. The top 3 most common cranial defects resulting in cranioplasty were nonspecific head trauma in 243 patients (%), followed by an infarct in 47 patients (8.7%), and vascular injury in 33 patients (6.1%). The mean time to cranioplasty was 8.51 months. The most frequent materials used in cranioplasty were autologous bone (62.8%), PMMA (24.8), and titanium (8.32%) implants. Five studies reported using 3D printing to make implant materials (27.8%). Overall, 79 patients (17.5%), experienced complications, with 23 patients (5.1%) experiencing infection and 11 patients (2.44%) experiencing wound dehiscence.

We report an overwhelming use of autologous bone flaps and PMMA implants for cranioplasty in LMIC due to their resource availability and cost-effectiveness, and a complication rate similar to the existing US-centric literature.