الفهرس 
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Abstract
Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair skull defects. The most common causes leading to calvarial skull defects include: depressed fractures of the skull, decompressive craniectomies (DC), tumor infiltration of calvarial bones, congenital deformities and inflammatory lesions.
Many characteristics have been suggested to describe the ideal alloplastic material for cranioplasty such as biocompatibility, tissue tolerance, simplicity of manufacture, ease of sterilization, low thermal conductivity, radiolucency, lightweight, resistance to infections, low cost and ready to use.
This study was aiming to compare the outcome of two different manufacturing processes in reconstruction of calvarial skull defects using Titanium mesh versus Hydroxyapatite bone cement with assessment of cosmetic, functional outcome and incidence of complications in both study groups.
This study was conducted upon 40 patients operated in neurosurgery department in Minia university hospitals to compare the outcome of two different manufacturing processes in reconstruction of calvarial skull defects using Titanium mesh versus HA bone cement implant with assessment of cosmetic, functional outcome and incidence of complications in both study groups.
Informed written consent was obtained prior to participation in the study from all patients.
Complete medical history was taken from all patients. Then assessment of general condition and neurological status was done. Preoperative skull X-ray and CT scans with bone window &3D reconstruction have been done for all the patients. Finally, complete lab investigations for all patients were needed to determine the surgical fitness for operation.
Under complete septic techniques, the old scar was then opened using a scalpel and sharp dissection of pericranium and adhesions was done to expose bone all around the defect
For Titanium mesh, the skull defect was covered by using 0.6-mm-thick titanium mesh plates. The titanium mesh was cut with a titanium scissor several millimeters larger than the defect The shape of the mesh can be readily modified with the gloved fingers. The mesh was fixed using several 4-mm cranial screws.
For HA bone cement, Refreshment of edges of bone defect all around. A saline soaked gel foam was placed over the dura before placing the cement and molding it to fit in the defect. It was continuously irrigated with cold saline to protect the brain from the excess heat produced. Then the graft was fixed in place using Vicryl sutures.
Titanium mesh provides less rate of complications. There is a statistically significant difference between both study groups as regards late complications with large skull defects. So that, the low incidence of complications with reconstruction of large skull defects using Titanium mesh gives it a high priority on choosing the proper procedure preoperatively.
Otherwise, both techniques proved to have non-significant difference in outcome regarding cosmetic appearance, functional outcome and improvement of the clinical symptoms (syndrome of trephined).