The outcome of Titanium Mesh Cranioplasty


  • Mahmood Khan Kibzai
  • Muhammad Shoaib Kibzai
  • Muhammad Haroon
  • Zeenat-un-Nisa



Traumatic head injury, Road traffic accident, pediatric group


Objective:The purpose of this study was to report on the result and complications of titanium mesh cranioplasty in patients with trauma.

Materials and Methods:The patients who underwent craniectomy previously for acute subdural hematomas (20 cases) or depressed fractures (40 cases) following RTA (road traffic accidents) were included in the study. Titanium mesh was placed on the skull defect 3–6 months later in the private hospitals of Quetta. The resulting complications were reported.

Results:There were 50 male and 10 female patients. The majority (66.66%) of patients were from the age group 15–40 years. The majority of patients (83.33%) did not develop any complications. 8.3% of patients had wound infections, 3.3%had mesh exposures, 1.6% developed loosening screws and 1.6% had mesh indentation due to external pressure.

Conclusion:This study concludes that there are few patients (<20%) who develop complications after cranioplasty. The study’s findings will assist neurosurgeons in the clinical decision-making process.Keywords:Titanium Mesh Cranioplasty, Acute Subdural Hematoma, Road Traffic Accident, Depressed Fractures


McKinlay A, Grace RC, Horwood LJ, Fergusson DM, Ridder EM, MacFarlane MR. Prevalence of traumatic brain injury among children, adolescents and young adults: prospective evidence from a birth cohort. Brain Injury. 2008 Jan 1;22(2):175-81.

Hiu Lam W, Mackersie A. Paediatric head injury: incidence, aetiology and management. Pediatric Anesthesia. 1999 Sep 1;9(5):377-85.

Walker PA, Harting MT, Baumgartner JE, Fletcher S, Strobel N, Cox Jr CS. Modern approaches to pediatric brain injury therapy. J Trauma. 2009 Aug;67(2 Suppl):S120.

Heskestad B, Baardsen R, Helseth E, Romner B, Waterloo K, Ingebrigtsen T. Incidence of hospital referred head injuries in Norway: a population based survey from the Stavanger region. Scandinavian journal of trauma, resuscitation and emergency medicine. 2009 Feb 20;17(1):6.

Koepsell TD, Rivara FP, Vavilala MS, Wang J, Temkin N, Jaffe KM, Durbin DR. Incidence and descriptive epidemiologic features of traumatic brain injury in King County, Washington. Pediatrics. 2011 Sep 27;10;125.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974 Jul 13;304(7872):81-4.

Hamilton BE, Hoyert DL, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2010–2011. Pediatrics. 2013;131:548–58.

Keenan HT, Runyan DK, Nocera M. Longitudinal follow-up of families and young children with traumatic brain injury. Pediatrics. 2006 Apr 1;117(4):1291-7.

Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabilitation. 2006 Sep 1;21(5):375-8.

Ducrocq SC, Meyer PG, Orliaguet GA, Blanot S, Laurent-Vannier A, Renier D, et al. Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center. Pediatric Critical Care Med. 2006 Sep 1;7(5):461-7.

Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J, Sharpin C, et al. meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Childhood. 2004 Jul 1;89(7):653-9.

Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J. 1971 May 22;2(5759):430-1.

Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics. 1974 Oct 1;54(4):396-403.

Adelson P, Bratton S, Carney N, Chestnut R, du Coudray H, Goldstein B, et al. Guidelines for theacute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatric Crit Care Med. 2003;4(3):1–75.

Hall P, Fransson A, Martens A, Johanson L, Leitz W, Granath F. Increasednumber of cancer cases following computer tomography in children. Radiation dosage–and cancer risk–can be reduced. Lakartidningen. 2005;102(4):214–5. 217, 220.

Agrawal D, Ahmed S, Khan S, Gupta D, Sinha S, Satyarthee GD. Outcome in 2068 patients of head injury: Experience at a level 1 trauma centre in India. Asian J Neurosurgery. 2016 Apr;11(2):143.

Anderson T, Heitger M, Macleod AD. Concussion and Mild head Injury. Pract Neurol. 2006;6:342?7.

Adirim TA, Wright JL, Lee E, Lomax TA, Chamberlain JM. Injury surveillance in a pediatric emergency department. Am J Emerg Med. 1999;17:499–503.

Ashaleye CM, Famurewa OC, Komolafe EO, Komolafe MA, Amusa YB. The pattern of computerised tomographic findings in moderate and severe head injuries in Ile?Ife, Nigeria. West Afr J Radiol. 2005;12:8?13.

Ogunseyinde AO, Obajimi MO, Ogundare SM. Radiological evaluation of head trauma by computed tomography in Ibadan, Nigeria. West Afr J Med. 1999;18:33?8.

Akang EE, Kuti MA, Ogunkoya AO, Komolafe EO, Malomo AO, Shokunbi MT, et al. Pattern of fatal head injuries in Ibadan??a 10?year review. Med Sci Law. 2002;42:160?6.

Emejulu JK, Shokunbi MT. Aetiological patterns and management outcomes of paediatric head trauma: one year prospective study. Nig J Clin Pract. 2010;13:276?9.

Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet. 2008;7:728-41.

Pathak A, Desania NL, Verma R. Profile of road traffic accidents and head injury in Jaipur. J Indian Acad Forensic Med. 2008;30:6-9.

Ghebrehiwet M, Quan LH, Andebirhan T. The profile of CT scan findings in acute head trauma in Orotta Hospital, Asmara, Eritrea. J Eritrean Med Assoc. 2008;5:5-8.

Ohaegbulam SC, Mezue WC, Ndubuisi CA, Erechukwu UA, Ani CO. Cranial computed tomography scan findings in head trauma patients in Enugu, Nigeria. Surg Neurol Int. 2011;2:136.

Becker DP, Miller JD, Ward JD. Theoutcome from severe head injury with earlydiagnosis and intensive management. J Neurosurg. 1977;47:491-502.

Jennett B, Teasdale G, Galbraith S. Severe head injuries in three countries. J Neurol Neurosurg Psychiatry. 1977;40:291-8.

Jennett B, Teasdale G, Braakman R. Predicting outcome in individual patients aftersevere head injury. Lancet. 1976;1:1031-4.

Cedermark J. Ober Verlauf, Symptomatologieund Prognose Kraniozerebraler Verletzungen. Acta Chir Scand. 1942;86 (Suppl 75):145.

Akerlund E. The late prognosis in severe headinjuries. Aeta Chit Stand. 1959;117:275-7.

Hendrick EB. The use of hypothermia insevere head injury in childhood. Arch Surg. 1959;79:362-4.

Pazzaglia P, Frank G, Frank F. Clinicalcourse and prognosis of acute post-traumaticdoma. J Neurol Neurosurg Psychiatry. 1975;38:149-54.