Cranioplasty in the Sultanate of Oman

Objectives: Cranioplasty is a complex craniofacial and neurosurgical procedure, which aims to reinstate the architecture of the cranial vault and elevate both aesthetic and neurological function. Several reconstructive materials have been thoroughly explored in the search for the optimal solution for cranioplasty. Methods: A retrospective analysis was carried out on all cranioplasty procedures performed at Khoula Hospital from 2012 to 2022. This study encompassed a total of 47 patients. The data collection process involved gathering demographic information, the characteristics of the cranial defect, and any complications that occurred post-operatively. Results: The most common cause of cranial defects is craniectomy following traumatic head injury (70.2%), along with excision of fibrous dysplasia (10.6%). The most frequently utilized material for cranial repair was autologous bone graft (n=28), followed by PEEK (n=14). Interestingly, the replacement of bone graft from previous craniectomy showed a notably high resorption rate (71.4%), in contrast to split calvarial grafts (0%) and other types of bone grafts (14.3%). Additionally, delayed graft infection was observed in 3.6% of the bone graft group and 7.1% of the PEEK group. Conclusion: Patient-specific alloplastic implants such as PEEK, have gained popularity for large and complex cranioplasty, as they provide excellent aesthetic outcomes and leave no donor site morbidity. In contrast, bone graft remains the gold stander for small to medium sized cranial defects. Keywords: Cranial Reconstruction; Cranioplasty; bone graft; PEEK