Cranioplasty in Europe: Evolution of Methods and Materials
🔍 How is the approach to skull restoration changing?
Cranioplasty is a surgical procedure to repair bone defects in the skull, most often following decompressive craniectomy (surgery to relieve intracranial pressure). The choice of material for the surgery remains a subject of intense debate: traditionally, the patient's own bone has been used, but in recent years, synthetic implants (alloplastic materials) have become increasingly popular.
A new study published in Brain and Spine represents the largest European survey of neurosurgeons, analysing preferences in cranioplasty techniques and materials, as well as the impact of new regulatory restrictions.
📊 How was the study conducted?
✅ Survey of neurosurgeons from 20 European countries ✅ 110 clinics took part in the study ✅ Data analysis from January to March 2024
Participants answered questions about preferred materials for cranioplasty, methods of storing bone fragments, timing of surgery, and management of patients with hydrocephalus.
🦴 What material do surgeons choose?
📌 52% of surveyed neurosurgeons prefer synthetic implants (alloplasty) 📌 48% use the patient's autogenous bone
💡 Why are synthetic implants becoming more popular? ✔️ Lower risk of infection ✔️ No need to store bone fragment ✔️ Better fit and aesthetic results ✔️ Legal restrictions on storing autogenous bone in some European countries
🔍 What materials do surgeons choose? 🔹 48% – thermoplastics (PMMA, PEEK, PEKK) 🔹 37% – mineralized materials (calcium phosphate, bioglass) 🔹 11% – titanium plate 🔹 4% – other materials (e.g. polypropylene mesh with antibiotic)
⏳ When is the best time to have cranioplasty?
❗ The optimal timing of the operation is still being discussed.
📌 Patients with autogenous bone were more often operated within 8-12 weeks after craniectomy 📌 Patients with synthetic implants - more often after 12 weeks or more
✔️ Only 2% clinics perform “ultra-early” cranioplasty in the first 4 weeks ✔️ 84% surgeons perform the surgery after 2 months or later
💡 Why you shouldn't delay? 🔹 Early cranioplasty helps restore cerebrospinal fluid dynamics and improve blood flow in the brain 🔹 Patients recover faster
📦 How is the removed bone stored?
📌 68% clinics use ultra-cold freezers (-80°C) 📌 15% – store fragments in the patient’s abdominal cavity 📌 11% – combine both methods 📌 6% – use other methods (e.g. sterile containers with preservatives)
⚠️ 35 clinics (32%) have completely abandoned the use of autogenous bone!
💡 Main reasons for refusal: ✔️ Logistical difficulties of storage ✔️ Legal restrictions ✔️ Simplification of the surgical process
👶 Cranioplasty in children
📌 53% surgeons prefer autogenous bone in pediatric practice 📌 44% use synthetic materials 📌 3% combine both methods
💡 Why do surgeons choose autogenous bone in children? ✔️ Possibility of natural bone growth ✔️ Improved biocompatibility ✔️ Lower risk of rejection
🔹 However, studies show that when stored for more than 4 months, bone cells die, which can reduce the effectiveness of autogenous cranioplasty.
💧 Cranioplasty and hydrocephalus
📌 60% surgeons perform cranioplasty separately from shunt placement 📌 40% combine both interventions in one operation
💡 Some studies show that cranioplasty may improve CSF circulation and reduce the need for shunt placement.
🔎 What does this change?
☑️ Cranioplasty in Europe is shifting towards synthetic implants ☑️ Regulatory restrictions on autogenous bone storage are accelerating this shift ☑️ Early cranioplasty can speed up rehabilitation and improve prognosis
