Comparative outcome analysis of titanium mesh versus PMMA cranioplasty after decompressive craniectomy: a retrospective observational study at a tertiary care center in rural India.

Background Cranioplasty reshapes the neurocranium and viscerocranium after craniectomy, using various materials to meet essential features like stability, applicability, and biocompatibility. This study presents our experience with titanium mesh and freehand-moulded polymethylmethacrylate (PMMA) implants, focusing on their functional and cosmetic outcomes. Methods We retrospectively analysed 75 PMMA cranioplasty cases performed from January 1, 2021, to February 2024, comparing postoperative complications and costs between PMMA and titanium implants. Additionally, we assessed the functional and cosmetic outcomes post-surgery. Results Our study included 75 patients, averaging 34.5 years for PMMA implants and 35.5 years (range 22-72) for titanium implants. Of these, 43 received PMMA and 32 had titanium implants after decompressive craniectomy (DC), primarily due to trauma. The time from DC to cranioplasty was approximately 90 days for PMMA and 102 days for titanium mesh. Postoperative complications were higher with PMMA (16 patients) than with titanium mesh (6 patients), showing a significant difference (p=0.0074). Revision surgeries were needed for 2 PMMA patients and 1 titanium mesh patient. Cosmetic outcomes were slightly better with titanium mesh but not statistically significant. Conclusions Patients with PMMA implants had higher infection rates than those with titanium mesh implants. Titanium implants exhibited lower surgical site infections (SSIs) requiring removal, likely due to titanium’s strong osseointegration, enhancing the long-term success of the implants and better wound healing. KEYWORDS: Cranioplasty, Titanium mesh, Polymethylmethacrylate (PMMA), DECRA, Author: DR. Abhishek Kumar ( senior resident), Dr M. Faheem (assistant professor), Dr Hanuman Prasad (Assistant professor), Dr Sajag Gupta (Ap) Dr saurabh Tiwari (sr)