• Zefferino Rossini, Andrea Franzini, Ismail Zaed, Nicola Zingaretti, Federico Nicolosi, and Bruno Zanotti.
• Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy. Electronic address: zefferino.rossini@humanitas.it.
• World Neurosurg. 2020 Jun 1; 138: e922-e929.

BackgroundCranioplasty is a common neurosurgical procedure with the goal of restoring skull integrity. Custom-made porous hydroxyapatite prostheses have long been used for cranial reconstruction in patients with traumatic brain injury. We present a large consecutive series of 2 groups of patients undergoing cranioplasty with hydroxyapatite custom bone and compare the adverse events (AEs) between the 2 groups.MethodsWe examined a series of consecutive patients who underwent cranioplasty using custom-made porous hydroxyapatite implants following tumor resection and traumatic brain injury at a single center between March 2003 and May 2018. The implants were designed and produced according to the surgeon's specifications and based on the patient's computed tomography scan data obtained through a standardized protocol. AEs were recorded.ResultsInformation on 38 patients with tumor and 39 patients with traumatic brain injury was collected and analyzed. A significant difference in the timing of surgery was found between the 2 groups; single-stage surgery was performed in 84% of patients in the tumor versus 8% of those in the traumatic brain injury group (P < 0.0001). The rate of AEs was not significantly different between the 2 groups (P = 0.4309) and was not related to the timing of surgery.ConclusionsCustom-made hydroxyapatite cranioplasty is a solution for cranial reconstruction in patients with cranial tumors. The low incidence of AEs in a consecutive series of patients with either trauma or tumors demonstrates that these prostheses represent a safe solution independent of the characteristics of cases.Copyright © 2020 Elsevier Inc. All rights reserved.

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