Cranioplasty With Titanium Mesh Versus Pmma: A Prospective Observational Comparative Study

Background: Cranioplasty restores skull integrity and improves cosmesis following calvarial defects. Commonly used alloplasts include titanium mesh and polymethylmethacrylate (PMMA), yet evidence is mixed regarding their comparative outcomes (Höhne et al., 2018). To Objective: compare cosmetic results, complication profiles, and operative efficiency between titanium mesh and PMMA cranioplasty. We Methods: conducted a prospective observational cohort study at a tertiary center between July 2023 to March 2025. Adult patients with full-thickness calvarial defects (from trauma, decompressive craniectomy, or tumor) underwent cranioplasty using either titanium mesh or PMMA. Surgical technique was standardized as much as possible (Bor-Seng-Shu et al., 2015). Cosmetic outcomes were assessed via patient satisfaction and blinded panel review at 6 and 12 months. Complication rates and operative metrics were analyzed using Student's t-test and chi-square test (Orringer et al., 2013). A total of 80 patients were included (titanium mesh: n=42; PMMA: n=38). Baseline characterist Results: ics (age, sex, defect etiology and size) were similar between groups. Patient satisfaction was high in both groups (9.0 vs 9.1/10, p = .47) with no significant differences in cosmetic scores at 12 months. Complication rates were comparable (titanium: 19%; PMMA: 16%; p = .72). Infection occurred in 7.1% vs 7.9%; exposure in 4.8% vs 2.6%; fluid collections in 7% vs 13%; seizures and reoperation rates were similar (Javadi et al., 2022). Mean operative time for cranioplasty (dural exposure to closure) was 118 ± 30 minutes for titanium and 127 ± 25 minutes for PMMA (mean difference 9 minutes, p = 0.14). The slightly shorter duration in the titanium group reflected elimination of polymer mixing and curing time, though surgeons spent additional minutes contouring and securing the mesh (Morselli et al., 2023). Blood loss and length of hospital stay did not differ significantly between groups. Conclusions: Both materials yield excellent cosmesis and comparable safety profiles. Choice can be guided by clinical context, defect characteristics, and resource availability rather than inherent material superiority (Lethaus et al., 2011).