Balancing Form and Function: A Single-center Review of Autologous vs. Synthetic Grafts in Cranioplasty

Introduction: Cranioplasty following decompressive craniectomy restores cranial structure, shields brain tissue, and re-establishes facial symmetry. While both autologous bone grafts (ABGs) and synthetic grafts (SGs) are used, limited data compare their long-term outcomes. This study aims to assess the functional, aesthetic, and economic outcomes of each graft type to inform clinical decision-making.

Methods: This retrospective, single-center study included 200 adult patients who underwent cranioplasty using either ABGs or SGs from January 2017 to November 2023. Data on patient demographics, clinical variables, socioeconomic status, graft type, complications, and aesthetic outcomes (quantified by CT-based asymmetry scores) were analyzed. Significance was defined at p < 0.05.

Results: Of 200 patients, 82 (41%) received ABGs, and 118 (59%) received SGs. The SG cohort had a significantly higher univariate complication rate (81.8% vs. 18.2% for ABGs; p=0.001), but this was not significant in multivariate analysis (p=0.196). No significant differences in frontal (p=0.321) or parietal (p=0.348) asymmetry were observed, indicating similar aesthetic efficacy. ABGs were associated with a shorter median time to cranioplasty (106.5 vs. 117 days; p=0.038), contributing to potentially faster recovery and reduced hospitalization costs. Socioeconomic factors such as insurance type influenced graft selection, with ABGs more often chosen in patients with limited insurance coverage due to their lower cost.

Conclusion : ABGs and SGs achieve comparable functional and aesthetic outcomes in cranioplasty, though ABGs offer cost advantages and potentially fewer complications. Selection of graft type should consider patient-specific factors, including clinical needs, comorbidities, socioeconomic constraints, and injury context, to tailor treatment and optimize long-term outcomes. This analysis underscores the importance of individualized decision-making in cranioplasty to balance both patient satisfaction and healthcare resource utilization.