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

At present, there is no gold standard when looking at reconstructive evidence for cranioplasty with the use of autologous bone as well as other synthetic materials. Titanium has been considered recently as a good option due to its unique properties such as strength and biocompatibility. Numerous studies have previously compared titanium with autologous bone for cranioplasty yet no meta-analysis has been performed within the literature to provide guidelines for craniofacial surgeons. A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of electronic information was conducted to identify all comparative studies of autologous bone vs. titanium implants in cranioplasty following a craniectomy. The primary outcomes were measured as re-operation rates and cosmesis, the secondary outcome measures included the incidence of complications, for example, bone resorption and infection. Five studies were selected, enrolling 323 cases. A high reoperation rate (p > 0.007) was seen in autologous cranioplasty using bone due to the significantly high resorption rate reported in this group. Cosmetic outcomes demonstrated no significant difference between the two groups examined. Finally, costs and infection rates (p > 0.18) were found to be comparable. Overall, titanium implants used in cranioplasty offer lower re-operation rates in comparison to autologous bone grafts whilst there was no major increase in adverse outcomes such as postoperative cost or rates.