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Haewon Roh 1 Article
Outcomes of Cranioplasty Using Autologous Bone or 3D-Customized Titanium Mesh Following Decompressive Craniectomy for Traumatic Brain Injury: Differences in Complications
Junwon Kim, Jang Hun Kim, Jong Hyun Kim, Taek-Hyun Kwon, Haewon Roh
J Trauma Inj. 2019;32(4):202-209.   Published online December 30, 2019
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  • 6 Citations
AbstractAbstract PDF

Cranioplasty (CP) is often required for survival after decompressive craniectomy. Several materials, including autologous bone and various artificial materials, have been introduced for CP, but it remains unclear which material is best for CP. This study aimed to explore differences in complications between patients who underwent CP using an autologous bone flap versus a three-dimensional (3D) titanium mesh and to identify significant risk factors for post-CP complications.


In total, 44 patients were enrolled in this study and divided into two groups (autologous bone vs. 3D titanium mesh). In both groups, various post-CP complications were evaluated. Through a comparative analysis, we aimed to identify differences in complications between the two groups and, using binary logistic analysis, to determine significant factors associated with complications after CP.


In the autologous bone flap group, there were three cases of surgical infection (3/24, 12.5%) and 11 cases of bone flap resorption (BFR) (11/24, 45.83%). In the 3D titanium mesh group, there was only one case of surgical infection (1/20, 5%) and 11 cases of various complications, including mainly cosmetic issues (11/20, 55%). A subgroup risk factor analysis of CP with an autologous bone flap showed no risk factors that predicted BFR with statistical significance, although a marginal association was found between larger bone flaps and BFR (odds ratio [OR]=1.037, p=0.090). In patients treated with a 3D titanium mesh, multivariate analysis revealed that only the existence of a ventriculo-peritoneal shunt system was strongly associated with overall post-CP complications (OR=18.66, p=0.021).


Depending on which material was used, different complications could occur, and the rate of complications was relatively high in both groups. Hence, the material selected for CP should be selected based on individual patients’ conditions.



Citations to this article as recorded by  
  • Customized Additive Manufacturing in Bone Scaffolds—The Gateway to Precise Bone Defect Treatment
    Juncen Zhou, Carmine Wang See, Sai Sreenivasamurthy, Donghui Zhu
    Research.2023;[Epub]     CrossRef
  • Customized cost-effective polymethylmethacrylate cranioplasty: a cosmetic comparison with other low-cost methods of cranioplasty
    Manish Baldia, Mathew Joseph, Suryaprakash Sharma, Deva Kumar, Ashwin Retnam, Santosh Koshy, Reka Karuppusami
    Acta Neurochirurgica.2022; 164(3): 655.     CrossRef
  • Letter to the Editor: Complications following titanium cranioplasty compared with nontitanium implants cranioplasty: A systematic review and meta-analysis
    Michael Amoo, Jack Henry
    Journal of Clinical Neuroscience.2021; 87: 32.     CrossRef
  • Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression
    Jack Henry, Michael Amoo, Joseph Taylor, David P O’Brien
    Neurosurgery.2021; 89(3): 383.     CrossRef
  • Comparison of complications in cranioplasty with various materials: a systematic review and meta-analysis
    Liming Liu, Shou-Tao Lu, Ai-Hua Liu, Wen-Bo Hou, Wen-Rui Cao, Chao Zhou, Yu-Xia Yin, Kun-Shan Yuan, Han-Jie Liu, Ming-Guang Zhang, Hai-Jun Zhang
    British Journal of Neurosurgery.2020; 34(4): 388.     CrossRef
  • A Reappraisal of the Necessity of a Ventriculoperitoneal Shunt After Decompressive Craniectomy in Traumatic Brain Injury
    Seunghan Yu, Hyuk Jin Choi, Jung Hwan Lee, Mahnjeong Ha, Byung Chul Kim
    Journal of Trauma and Injury.2020; 33(4): 236.     CrossRef

J Trauma Inj : Journal of Trauma and Injury