Customized Osteomesh Cranioplasty


  • C.N. Yogishwarappa The Bangalore Medical College and Research Institute, Krishna Rajendra Road, Fort, Kalasipalyam, Bengaluru, Karnataka 560002, India
  • S. Srinivasan The Bangalore Medical College and Research Institute, Krishna Rajendra Road, Fort, Kalasipalyam, Bengaluru, Karnataka 560002, India
  • S.H. Teoh The Bangalore Medical College and Research Institute, Krishna Rajendra Road, Fort, Kalasipalyam, Bengaluru, Karnataka 560002, India
  • A. Vijayakumar The Bangalore Medical College and Research Institute, Krishna Rajendra Road, Fort, Kalasipalyam, Bengaluru, Karnataka 560002, India
  • M. Ishwar The Bangalore Medical College and Research Institute, Krishna Rajendra Road, Fort, Kalasipalyam, Bengaluru, Karnataka 560002, India



Cranioplasty, Composite graft, Osteomesh, Stem cells.


Cranioplasty, one of the oldest surgical procedures used to repair cranial defects, has undergone many revolutionary changes over time to find the ideal material to improve patient outcome.The surgical challenge in repairing large calvarial defects is known to craniofacial surgeons. Ongoing researches on various cranioplasty materials continue with the help of recent technology. Stem cell experiments and development of morphogenic proteins are expected to take the lead in future. With the aid of Computer Aided Designing technology, all currently used alloplastic materials can be custom made for even large skull defect. We present a case of young female patient following trauma underwent craniotomy and complicated with bone graft loss. Patient initially underwent cranioplasty using a PMMA implant, inspite of its excellent tensile strength was not proven to be effective it sustained fracture and got exposed. A customized osteomesh of polycaprolactone (PCL) with a titanium scaffold with bone morphogenic protein (BMP) was impregnated with stem cells was used in cranioplasty. This aided in osseoinduction, which was later proved by imaging. Empirically, there has been no ideal material for cranioplasty; however, materials that are strong, resistant to infection, radiolucent, inexpensive, and able to reincorporate with a patient's craniotomy defect will offer the greatest advantages for such patients and hence PCL with such qualities proves to be a good alternative.


Sanan A, Haines SJ. Repairing holes in the head: A history of cranioplasty. Neurosurgery 1997; 40: 588-603.

Aydin S, Kucukyuruk B, Abuzayed B, Aydin S, Sanus GZ. Cranioplasty: Review of materials and techniques. J Neurosci Rural Pract. 2011; 2(2): 162-167.

Blake DP. The use of synthetics in cranioplasty: A clinical review. Mil Med. 1994; 159: 466-9.

Moreira-Gonzalez A, Jackson IT, Miyawaki T, Barakat K, DiNick V. Clinical outcome in cranioplasty: critical review in long-term follow-up. J Craniofac Surg. 2003; 14: 144-153.

Beekmans SJ, Don Griot JP, Mulder JW. Split rib crartioplasty for aplasia cutis congenita and traumatic skull defects: more than 30 years of follow-up. J Craniofac Surg. 2007; 18: 594-7.

Frodel JL, Lee S. The use of high-density polyethylene implants in facial deformities. Arch Otolaryngol Head Neck Surg. 1998; 124: 1219-1223.

Prolo DJ, Burres KP, McLaughlin WT, Christensen AH. Autogenous skull cranioplasty: Fresh and preserved (frozen), with consideration of the cellular response. Neurosurgery 1979; 4: 18-29.

Viterbo F, Palhares A, Modenese E. Cranioplasty: The autograft option. J Craniofac Surg. 1995; 6: 80-3.

Zins JE, Langevin CJ, Nasir S. Controversies in skull reconstruction. J Craniofac Surg. 1998; 15: 20-26.

Black SP. Reconstruction of the supraorbital ridge using aluminum. Surg Neurol. 1978; 9: 121-8.

Abuzayed B, Tuzgen S, Canbaz B, Yuksel O, Tutunculer B, Sanus GZ. Reconstruction of growing skull fracture with in situ galeal graft duraplasty and porous polyethylene sheet. J Craniofac Surg. 2009; 20: 1245-9.

Hadley FA. Skull defects repaired by tibial grafts. J. Col Surg Australia I 1924; 208: I928-I929.

Taggard DA, Menezes AH. Successful use of rib grafts for cranioplasty in children. Pediatr Neurosurg. 2001; 34: 149- 55.

Westermann CWJ. Zur Mathodik der Deckung von Schadeldefekten. Zentralbl F Chir. 1916; 43: 113.

Dingman RO. Iliac bone cranioplasty. Plast Reconstr Surg. 1952; 9(2): 130-9.

Shoakazemi A, Flannery T, McConnell RS. Long-term outcome of subcutaneously preserved autologous cranioplasty. Neurosurgery 2009; 65: 505-510.

Pankratiev BE. Dead bone grafts to repair skull defects. Annal Surg. 1933; 97(3): 321-326.

Grant FC, Norcross NC. Repair of cranial defects by cranioplasty. Ann Surg. 1939; 110(4): 488-512.

Frey V. Tyber Einheilung von Celluloidplatten. Wein Klin Wchnischr. I894; 7: 40.

Alexander VG. Preformed polymethylmethacrylate cranioplasties. J Max-Fac Surg. 1985; 13: 2-8.

Gosain AK. Hydroxyapatite cement paste cranioplasty for the treatment of temporal hollowing after cranial vault remodeling in a growing child. J Craniofac Surg. 1997; 8: 506-11.

Chicarilli ZN, Ariyan S. Cranioplasty with a silicone prosthesis and split rib grafts. Head Neck Surg. 1986; 8: 355-62.

Liu JK, Gottfried ON, Cole CD, Dougherty W, Couldwell WT. Porous polyethylene implant for cranioplasty and skullbase reconstruction. Neurosurg Focus 2004; 16: ECP1.

Arnaud E, De Pollak C, Meunier A, Sedel L, Damien C, Petite H. Osteogenesis with coral is increased by BMP and BMC in a rat cranioplasty. Biomaterials 1999; 20: 1909-18.

Makela T. Tantalum cranioplasty of war wounds of the skull. Ann Chir Gynaecol Fenn. 1949; 38: 13-9.

Kuttenberger JJ, Hardt N. Long-term results following reconstruction of craniofacial defects with titanium micro-mesh systems. J Craniomaxillofac Surg. 2001; 29: 75-81.

Chen J, Qian C, Xie Y. Clinical analysis of 21 cases autologous skull fragments plasty in situ using platinum connector added medical glue. Modern Hospital 2009; 11: 020.

Campbell E, Meirowsky A, Tompkins V. Studies on the use of metals in surgery- part II: Experiments on the use of Ticonium in cranial repair. Annal Surg. 1942; 116(5): 763.

Yamada Y, Boo JS Ozawa R, Nagasaka T, Okazaki Y, Hata Ki, et al. Bone regeneration following injection of mesenchymal stem cells and fibrin glue with a biodegradable scaffold. J Craniomaxillofac Surg. 2003; 31(1): 27-33.

Haynesworth SE, Goshima J, Goldberg VM, Caplan AI. Characterization of cells with osteogenic potential from human marrow. Bone 1992; 13: 81-88.

Chan C, Thompson I, Robinson P, Wilson J, Hench L. Evaluation of bioglass/dextran composite as a bone graft substitute. Int J Oral Maxillofac Surg. 2002; 31: 73-77.

Gosain AK. Plastic Surgery Eductional Foundation DATA Committee. Biomaterials for reconstruction of the cranial vault. Plast Reconstr Surg. 2005; 116: 663-666.

Salyer KE, Bardach J, Squier CA, Gendler E, Kelly KM. Cranioplasty in the growing canine skull using demineralized perforated bone. Plast Reconstr Surg. 1995; 96: 770-779.

Clokie CM, Moghadam H, Jackson MT, Sandor GKB. Closure of critical size defects with allogeneic and alloplastic bone substitutes. J Craniofac Surg. 2002; 13: 111-121.

Erbe E, Marx J, Clineff T, Bellincampi L. Potential of an ultraporous β-tricalcium phosphate synthetic cancellous bone void filler and bone marrow aspirate composite graft. Eur Spine J. 2001; 10(2): S141-6.

Chen TM, Tsai JC, Burnouf T. Cranioplasty using osteoconductive polycaprolactone (PCL) (OsteoMesh® , Osteopore, Singapore) scaffold and platelet glue. J Trauma Acute Care Surg. 2008; 65(6): 1321-7.

Low SW, Ng YJ, Yeo TT, Chou N. Use of OsteoplugTM polycaprolactone implants as novel burr-hole covers Singapore. Med J. 2009; 50(8): 777.